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eCounseling Service Agreement

Participation in eCounseling Treatment

You, the client, are a full partner in counseling. Your honesty and effort is essential to success. If as we work together you have suggestions or concerns about your counseling, we expect you to share these with us so that we can make the necessary adjustments. If it develops that you would be better served by another mental health provider, we will help you with the referral process. If you are currently receiving services from another mental health professional, we expect you to inform us of this and grant us permission to share information with this professional so that we may coordinate our efforts.

Additionally, you determine the topics that we address in our work together, and the depth to which we address those topics.  Concerns related to depression, sadness, isolation, relationships, anxiety, stress, parenting, work or school performance, and family issues, among others, are all appropriate topics for your eCounseling sessions.  Although you are receiving support from trained and experienced professionals in the field, you are by no means obligated to apply the information given to you in this process.  You alone can decide what is best for you in your situation.

Confidentiality & Security

Unless we make other provisions, it is understood that our communication remains confidential.  This means that we will not release your information to anyone without your prior written consent, except in the following situations:

• You express intent to harm yourself or someone else;
  
  
• There is a reasonable suspicion of abuse/neglect against a minor child, elderly person (65 or older), or a dependant adult (i.e, you disclose this information to us);
  
  
• A court order is received directing the disclosure of information. It is our policy to assert privileged communication on behalf of the client and the right to consult with the client if at all possible, except during an emergency, before mandated disclosure.

We will endeavor to apprise clients of all mandated disclosures as conceivable.

It should be noted however that despite the great lengths to ensure secure connections Northshore Counseling and Wellness takes to protect your confidentiality online, there is ALWAYS the possibility that confidential information may be retrieved and that anything that the client chooses to discuss that may be confidential is discussed at the client’s own risk. If you are concerned about security of email on the Internet, please choose the option to encrypt the email.

Additionally, you are responsible for maintaining the security of information on your computer.  It is important to make sure that others cannot access the communications between us if you don’t want others seeing that information.

Location of eCounselors

All therapists are located in the state of Louisiana, and operate in accordance with the ethical guidelines for counselors within the state of Louisiana.

Termination of Treatment

It sometimes happens that clients or therapists determine that the client’s needs are best served elsewhere, or the client determines there is no longer a need for assistance.  We agree that either of us can terminate our relationship at any time for any reason.  If this occurs, any unused funds will be returned to you.  We do ask that you send us an email explaining your reasons for leaving so that we might fully understand how we can better help others in the future.  There will not be a charge for such an email if you decide to send one.  In the rare event that your counselor determines that it is appropriate to terminate the relationship, the reasons for doing so will also be explained to you.

Crisis Situations

We agree that due to the method of communication we are using for counseling, we are not equipped to handle crisis situations.  If you are feeling like harming yourself or someone else, you are having a mental health emergency and it is probably best that you retain immediate help to get through this difficult time.  We encourage you to let people who support you (family, friends) or the police or ER staff know that you are in need of assistance.  There is also a suicide hotline that can be help to you:
1-800-SUICIDE (784-2433).
 
The following are the names and license information of the therapists with whom you may choose to work:

                Andre S. Judice, Ph.D., LPC #2479 (Louisiana), LMFT #529 (Louisiana)

                Micah P. Hatchett, Ph.D., LPC #2847 (Louisiana)

                Natalie Toth, LPC #3446 LMHC #5706 (Louisiana)

                Alison Matern, LPC-I #216076 (Louisiana)

About our eCounselors

To read more about each therapist, please see our Staff Bio Page. 

Any complaints can All counselors are registered with the LICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS, 8631 SUMMA AVENUE, BATON ROUGE, LOUISIANA 70809 TELEPHONE (225)765-2515.

 

By typing in your name and the date above, you agree to and understand the above informed consent. Please print a copy of this page for your records.