It is understood (and agreed) that all statements, whether written or verbal, with your pastoral counselor(s) are of a confidential nature and ethically cannot be disclosed, without your written consent, with the following exceptions that will result in confidentiality being waived.
- Suspicion of child/elder abuse. We reserve the right and/or may be mandated by law to report child abuse or suspicion of child/elder abuse of any type to the proper authorities and/or the right to cause a report of child/elder abuse to occur.
- Threats of harm to self or others. We reserve the right and/or may be mandated by law to disclose the appropriate person, agency, or civil authorities any threats of harm that a person may attempt or desire to do to ones self or to others.
- Necessity of consultation. We reserve the right to consult with other counseling professionals or appropriate church ministry staff members regarding your sessions, only when absolutely necessary. This consultation will be held in the same level of confidence as your sessions.
Waiver of Liability: In consideration for receiving any form of counseling from the Heart of Worship Church pastors, the person receiving the counseling agrees to release and waive any and all claims of any kind against the ministry, the staff, the pastoral counselors, or the Church, which may arise from, result out of, or be related to, conduct or advice given.
Counseling Files: Any counseling files and their contents belong to the Pastoral Counseling Ministry. They are considered confidential in nature and ethically cannot be disclosed, without your written consent.
Availability: Our ministry often carries an extensive waiting list. Members of Heart of Worship Church will be given priority on our waiting list. We will gladly see non-members if our schedule allows. If our waiting list is prohibitive, we may offer outside referral options. Our ministry is available on an appointment basis.
Cancellations or Reschedules: We often carry an extensive waiting list and have limited time available, therefore, if you need to reschedule or cancel an appointment, we ask that you call at least 24 hours in advance. This allows us to reschedule others who are on our waiting list. Repeated failure to keep appointments (2 cancellations or no shows) or give proper notice of cancellation will result in termination of the session(s).
I have carefully read this information sheet and agree to all of the stated terms and conditions. I also agree that all the information on my personal data form is true and complete to the best of my knowledge.