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Professional Disclosure Statement

This document is a professional disclosure statement from Lindsay Frye, a Licensed Clinical Mental Health Counselor Associate practicing at The Haymount Institute. It summarizes her qualifications and licensure status, counseling background and approach, session fees and lengths, policies around diagnosis and confidentiality, and information on filing a complaint. The statement is meant to clearly outline the terms of counseling services for clients.

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2K views

Professional Disclosure Statement

This document is a professional disclosure statement from Lindsay Frye, a Licensed Clinical Mental Health Counselor Associate practicing at The Haymount Institute. It summarizes her qualifications and licensure status, counseling background and approach, session fees and lengths, policies around diagnosis and confidentiality, and information on filing a complaint. The statement is meant to clearly outline the terms of counseling services for clients.

Uploaded by

api-508872131
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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Professional Disclosure Statement

Lindsay Frye, LCMHCA


The Haymount Institute
806 Hay Street, Fayetteville, NC 28305
Phone: 910.860.7008 ext. ##
Fax: 910.221.9006
Office Email: ______________

Qualifications
I am a Licensed Clinical Mental Health Counselor Associate (LCMHCA) in the State of North Carolina.
I graduated from Wake Forest University in May 2020 with my master’s degree in Clinical Mental
Health Counseling.

Licensure
I am currently practicing under a restricted license, A0000. This license is the pre-requisite for the
LCMHC license for new graduates and new counseling professionals. I am working towards my full
unrestricted licensure as an LCMHC 0000. I will be fully licensed once I achieve 3000 hours of practice
as Clinical Mental Health Counselor. I am also under supervision by a Licensed Clinical Mental Health
Supervising Counselor while practicing with my restricted license. My supervisor is Maria Russell,
LCMHCS. She can be contacted by phone at 704-###-####.

Counseling Background
I believe that counseling is a unique experience based on a relationship of trust. I operate from a person-
centered approach and incorporate wellness techniques, strengths-based counseling strategies, cognitive-
behavioral strategies, and energy psychology methods into my practice. I am practicing these therapeutic
techniques with teenagers and adults, as well as utilizing play therapy techniques and creative
interventions with adolescents. I completed my internship experience at The Mindly Group, in Raleigh,
NC, where I worked with clients ages 5-50 on a wide range of mental health and wellness concerns
including depression, anxiety, family relationships, personal growth, and stress-management.

Session Fees and Length of Service


Initial intake sessions are 90 minutes and are scheduled through The Haymount office. Individual
sessions are 50 minutes in length and are scheduled directly with me after the initial intake. Fees for
services are as follows: ____. I accept the following insurances: ________. If you have any questions
about billing or service fees, please ask me directly or call our office at 910.860.7008 to be connected
with a billing manager.
Use of Diagnosis
Some health insurance companies will reimburse clients for counseling services and some will not. In
addition, most companies require that a diagnosis must be rendered if the client is going to be
reimbursed. Some conditions for which people seek counseling do not qualify for diagnosis. If a
qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis before we submit the
diagnosis to the health insurance company. Any diagnosis made will become part of your permanent
insurance records.

Confidentiality
All of our communication becomes part of the clinical record, which is accessible to you upon request. I
will keep confidential anything you say as part of our counseling relationship, with the following
exceptions: (a) you direct me in writing to disclose information to someone else, (b) it is determined
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you are a danger to yourself or others (including child or elder abuse), or (c) I am ordered by a court to
disclose information.

Concerns
Although clients are encouraged to discuss any concerns with me, you may file a complaint against me
with the organization below should you feel I am in violation of any of these codes of ethics. I abide by
the ACA Code of Ethics (http://www.counseling.org/Resources/aca-code-of-ethics.pdf).

North Carolina Board of Licensed Clinical Mental Health Counselors


P.O. Box 77819
Greensboro, NC 27417
Phone: 844-622-3572 or 336-217-6007
Fax: 336-217-9450
E-mail: [email protected]

Acceptance of Terms
We agree to these terms and will abide by these guidelines.

Client: ___________________________________________________ Date: ___________

Counselor: ________________________________________________ Date: ___________

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