PLEASE PRINT THIS DISCLOSURE STATEMENT AND KEEP FOR YOUR RECORDS.

Tamara Jones, M.A., NCC, LPC

Licensure in State of Colorado awarded.

National Counseling Certification awarded.

Master of Arts degree in Counseling Psychology from the University of Colorado at Denver awarded.

Bachelor of Arts degree in Psychology from the University of Vermont.

The Colorado Department of Regulatory Agencies has the responsibility of regulating the practice of licensed psychologists, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists, certified school psychologists, and unlicensed individuals who practice psychotherapy. 

The agency within the department that has responsibility specifically for licensed psychotherapists is the State Grievance Board, 1560 Broadway, Suite 1340, Denver, CO, 80202, 303.894.7800.

Client Rights and Important Information

1.You are entitled to receive information from me about my methods of therapy, the techniques I use, the duration of your therapy (if I can determine it), and my fee structure. 

2.You can seek a second opinion from another therapist or terminate therapy at any time. 

3.In a professional relationship (such as ours), sexual intimacy is NEVER appropriate.

4.Generally speaking, information provided by and to a client during therapy sessions with a licensed professional counselor (LPC), is legally confidential.

Information disclosed to a licensed professional counselor (LPC),  is privileged communication and cannot be disclosed in any court of competent jurisdiction in the State of Colorado without the consent of the person to whom the testimony sought relates.

THERE ARE EXCEPTIONS TO THE GENERAL RULE OF LEGAL CONFIDENTIALITY.  

These exceptions are listed in the Colorado statutes (see section 12-43-218, C.R.S., in particular). 

You should be aware that legal confidentiality does not apply in a criminal or delinquency proceeding.

There are other exceptions to confidentiality that I will identify to you at the start of therapy:

1.If you are in danger of hurting yourself or another person.

2.If child abuse or elder abuse is disclosed. 

3.If a court requests counseling documents.

If you have any questions or concerns about this disclosure statement and/or would like additional information,

please feel free to ask.

I have read the preceding information and understand my rights as a client/patient.

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Client Signature                                                        Date