Counseling Agreement

Grace Counseling Christian Counseling with Christian Principles

I /We, (FIRST AND LAST NAME TYPED ON ORDER), the client or clients, referred to as I or client, have been informed by Grace Counseling, referred to as Grace Counseling and Training, that Biblical Counseling and spiritual guidance are being provided, that this agreement shall govern the professional relationship between parties, that any disputes or modifications or agreement shall be negotiated directly between parties. In the event of a lawsuit, the client may assume all the costs of litigation including adjunct costs and fees, and all attorney fees.

Counselor and Qualifications:  Dr. Carol S. Martin is a Licensed Minister of the Gospel and is a Licensed Clinical Pastoral Counselor Advanced Certificate, Licensed Clinical Christian Counselor, and a Board Clinical Supervisor, Licensed by the National Christian Counselors Association, License # 12800. Carol S. Martin holds a degree in Doctor of Theology, Doctor of Ministry, and a Doctor of Christian Psychology. She is a Certified Temperament Therapist, Board Certified in Child and Adolescent Therapy, Board Certified in Substance Abuse and Addiction Therapy. She has also completed the Drug Recognition Expert training through the Ohio State Highway Patrol. Court appointed counseling cases will be considered on an individual basis and will require the proper release of information. Dr. Carol S. Martin is not a secular psychologist, psychiatrist and is not a state licensed counselor. Due to the Pastoral nature of these services she will not testify in court or act as a professional witness.

Biblical Basis:  Grace Counseling is a faith based ministry and as such will pray with and for clients, use the Bible as the foundation of counseling and will encourage personal devotions. I understand that this is Biblical Christian Counseling and not a secular service by a state licensed counselor. I further understand that no guaranties have been given as to the outcome of the counseling process and that I /we, the counselee play a vital role in the results of counseling. I agree to make a good faith effort in the counseling process, which includes honest participation during sessions and participation in homework given.

Confidentiality & Mandated Reporting:  This ministry operates under the clergy / client confidentiality privilege, which means that communication between the client and minister of counseling is confidential. However, there are some exceptions when the counselor without the consent of the client may break confidentiality. These include reasonable suspicion of the threat of serious harm to self or others, child abuse, abuse of the elderly or disabled or when otherwise required by law. Reasonable Suspicion is defined as, but not limited to credible evidence that abuse or neglect has or may have occurred, that a threat of serious harm has or may occur, significant discrepancies in or significantly inconsistent explanations of injury.

Location and Confidentiality:  Grace Counseling is located at 4756-D Fishburg Rd, Huber Heights, Ohio. Grace Counseling goes to great lengths to protect your identity, personal information and case notes. There may also be times when meetings take place outside of the Grace Counseling office and these policies are still applicable.

Fees and Billing:  Fees are determined by Grace Counseling and full payment shall be made at the beginning of each session. Payments can be made with cash or check made payable to Grace Counseling. Grace Counseling will not extend credit. A $25.00 fee will be applied to all NSF payments.

Canceling Appointments:  The cancellation policy with Grace Counseling is when you make an appointment, that time is reserved for you. In the event that you must cancel an appointment, for whatever the reason, you will be charged the full session rate. If the need arises to reschedule within the same week, no additional charges applies. Please note that you are ultimately responsible for all charges incurred.

 Assignments:  It is vital that you the client do the assignments the counselor gives. As the Bible says you will reap what you sow. If you put forth a halfhearted attempt at the homework you will get a halfhearted return. There is no magic button a counselor can push to bring about healing or to impart truth and new understanding. It requires your desire and effort. It is nearly impossible to help someone that chooses not to participate in their own healing. We firmly believe that the client should have more invested in solving their issues than the counselor.

Terminating Counseling:  Counseling is normally terminated by mutual consent between the client and counselor because they have reached the set goals. This can occur in either verbal or written form. However, both the client and the counselor have the right to terminate counseling at any time. If you the client miss schedule appointments, fail to schedule an appointment for two consecutive weeks (unless previously agreed upon) or do not reply to our attempts to contact you, Grace Counseling will take this as you have chosen to terminate counseling.

Counseling Agreement:  I understand and of my own free will accept and agree to abide by this two page Informed Consent Agreement as presented. I also agree to release all liability, in any form, that may be charged against Grace Counseling or Dr. Carol S. Martin. I understand my personal responsibility to maintain confidentiality, and that bringing a third party into the counseling appointment may waive the confidential communication privilege during that session. If any of these policies are found to be unenforceable the rest of the agreement is still in effect.