Professional Disclosure & Informed Consent
Introduction
Welcome to Enviro-Mental Health Consulting. This document outlines important information about our consulting services, including your rights and responsibilities.
Please read it carefully and sign below to indicate your understanding and consent.
**1. Nature of Consulting Services**
Enviro-Mental Health Consulting focuses on personal and professional development, environmental awareness, and mental well-being. Please note that consulting is not a substitute for psychotherapy, medical treatment, or any other professional services. Our services are designed to facilitate personal and organizational growth and help you achieve increased resilience and support.
**2. Confidentiality**
We are committed to maintaining the confidentiality of your personal information. Any information shared during consulting sessions will be kept confidential, except in cases where disclosure is required by law or where there is a risk of harm to yourself or others. In such cases, we may be required to share information with appropriate authorities.
**3. Liability and Limitations**
While we strive to provide high-quality services, consulting is a collaborative process and its outcomes depend on various factors including your level of engagement and effort. Enviro-Mental Health Consulting, its employees, and representatives cannot guarantee specific results or outcomes. By participating in our services, you acknowledge that:
- Consulting is not a substitute for medical or psychological treatment.
- You are responsible for making your own decisions and taking actions based on the guidance provided during sessions.
- We are not liable for any adverse outcomes resulting from your decisions or actions taken as a result of consulting.
**4. Informed Consent**
By signing this form, you consent to participate in consulting services provided by Enviro-Mental Health Consulting. You understand and agree to:
- Provide accurate and complete information about your goals and concerns.
- Actively participate in the consulting process.
- Communicate any changes in your needs or concerns promptly.
**5. Fees and Payment**
Consulting fees are outlined in the agreement you will receive separately. Payment is due as specified in that agreement. Please review the fee structure and payment terms to ensure you understand and agree to them.
**6. Cancellation Policy**
Client agrees that it is the Client's responsibility to notify the Consultant 24 hours in advance of the scheduled calls/meetings. Consultant reserves the right to bill Client for a missed meeting. Consultant will attempt in good faith to reschedule the missed meeting.
**6. Termination of Services**
You or Enviro-Mental Health Consulting may terminate consulting services at any time. If you choose to discontinue, please notify us in writing. Any outstanding fees will be due at the time of termination.
**7. Acknowledgment and Agreement**
By signing below, you acknowledge that you have read, understood, and agree to the terms outlined in this Professional Disclosure and Consent Form. You understand that consulting is a collaborative process and agree to participate fully.
Client Information
Name: ____________________________________
Signature: _________________________________
Date: _____________________________________
Consultant Information
Name: ____________________________________
Signature: _________________________________
Date: _____________________________________
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Contact Information
For any questions or concerns regarding this form or our services, please contact us at:
Enviro-Mental Health Consulting
Email: enviro.mentalhealth.consulting@gmail.com
Phone: 585-402-6713