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Dinah Wade
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InformationDisclosure and Consent Statement 
It is my pleasure to serve you as you seek counseling assistance. This packet contains information you may need to refer to during our counseling relationship. If you have questions about the policies of Grace Counseling Center, please do not hesitate to ask me. 

GENERAL INFORMATION
 
I use an approach to counseling which takes into account your spiritual, emotional, physical and social dimensions.  One of your primary tasks will be todetermine your goals for counseling. These goals may evolve as we work together.  Whatever your goals, my hope for you is that you grow and mature, reaching a point at which you are able to resolve your problems ordevelop alternatives for living with these problems.  It is, however, impossible to guarantee any specificresults. I work primarily with adults and adolescents.  I offer individual, marital, family and group therapies.  I work commonly withmen and women with the following kinds of issues: depression, marital struggles, recovery from past childhood abuse, sexual abuse, anxiety, anger, andcompulsions.  I will address your individual issues in the context of encouraging yourspiritual growth. I have a growing interest and training in the Enneagram, and have taught the Enneagram. I am a member of the American Association of Christian Counselors and Texas Counselors Association. I am authorized to administer the Gottman marital assessment as a trained Gottman therapist. 

QUALIFICATIONS
 
I am a Licensed Professional Counselor (LPC) with thestate of Texas (license # 14632). I assure you that my services will be rendered in a professional mannerconsistent with accepted ethical standards as established by the Texas State Board of Examiners of Licensed Professional Counselors.

I completed my undergraduate studies at Oklahoma State University with a Bachelor of Arts degree in English after having attended three colleges in three different states. As the wife of an Air Force Pilot, we lived in several states around the country. During those years, I taught English to high school students, volunteered with various organizations, and had two children. My husband retired from the Air Force and both of us attended Colorado Christian University, completing a Master of Arts degree in Biblical Counseling under the direction of Dr. Larry Crabb and Dr. Dan Allender. I have maintained a counseling practice since 1996 in the San Antonio area, and we opened Grace Counseling Center in 2000 in Boerne. I have been associated with various evangelical churches.

CONFIDENTIALITY
 
I will keep absolutely confidential anything you say to me with certain exceptions.  Theseare: (a) you direct me to tell someone else; (b) I determine you are a dangerto yourself or to someone else; (c) a court orders me to disclose certaininformation; or (d) child abuse is taking place.  In this final case, I am required by law to disclose thisinformation to Texas Child Protective Services.    

FINANCIAL POLICIES AND INSURANCE PROCEDURES
 
Counseling sessions will be generally 50 minutes in lengthunless otherwise arranged.  I meetwith most of my clients on a weekly basis.  Occasionally, I meet more or less frequently, depending onthe client’s need.  I require full payment for counseling at the scheduled appointment in most cases.  Please make your payment at the conclusion of each session unless other arrangements are made.  If you pay by check, please try to fillout your check ahead of time.  I also accept Master Card or Visa. 

CANCELLATION POLICY:
 
In the event that you will not be able to keep a scheduledappointment, please notify my office at least 24 hours in advance of yourappointment.  If I do not receivesuch advance notice, you will be responsible for paying the full fee forthe session you missed.  If anotherparty supplements your counseling fees, you will be responsible for paying thefee rather than that party.  Pleasebe advised that two consecutive missed sessions without notice or extenuatingcircumstances may constitute a termination of our therapeutic relationship. If you wish to seek full or partial reimbursement for myservices from your health insurance company, I will be happy to provide all thenecessary information your insurance company requires for submitting yourclaim.  Please advise me of yourintentions to file your claim and I will mail invoices to you on a monthlybasis.  If I am in your mental health network, I will ask you to complete a form to obtain your insurance information, and fileyour claims in our office.  Healthinsurance companies require that I diagnose and disclose your mental healthcondition to them in accordance with Diagnostic and Statistical Manual (DSM-IV)standards of diagnosis.  Any diagnosis made will become part of your permanent insurance records.  Please speak with me regarding anyspecific questions concerning these procedures. 

ADDITIONAL INFORMATION
 
The process of helping you address troubling areas of yourlife is unique in that it inevitably is the catalyst for one or more personalissues to arise that may cause some degree of personal distress.  The fact that this happens is a normaland natural part of the counseling process.  It is my privilege, as the one you have chosen to beinvolved in this process, to help you work through these problems.  To this end, I anticipate and desire agood and productive professional relationship with you.  The relationship we establish andmaintain will be characterized by mutual respect and openness.  However, in the event that a particulardissatisfaction with my services should arise, I will be very willing todiscuss the nature of your dissatisfaction and make a concerted effort to movetoward a reasonable solution.  If for some reason we are unable to arrive at an acceptable solution, I will bewilling to provide you with several possible alternative referral sources.  However, should you believe itnecessary to make a formal complaint regarding your counseling experience, youmay contact the Texas State Board of Examiners of Licensed ProfessionalCounselors in Austin, Texas at the following: 
1100 West 49thStreetAustin, TX78756-3183(512) 834-6658 

EMERGENCIES 
As my client, I ask you to agree to the following guidelinesregarding emergencies.  In theevent of a crisis that you feel you are unable to handle alone, please do thefollowing in the specified order: 
1. Contact a family member for assistance.  If you are unable to resolve the crisisand/or contact a family member, you will: 
2. Contact me at 830-249-9977 if it is during normal business hours, leaving a clear message that youhave an emergency.  If you cannotcontact me, you will: 
3. Either call Laurel Ridge Hospital at (210) 491-9400 forassistance or present yourself in person at 17720 Corporate Woods Drive, SanAntonio, Texas.  If you do none ofthe above, you will: 
4. Call “911” for emergency assistance. 

If you have any questions about the information containedherein, or about the counseling process in general, please feel free to ask me.