Please note that you do not have to be a Christian to participate in the counseling services provided.  I have been trained as a professional counselor at Eastern Illinois University.  I believe that the principles taught in scripture are the best methods for growth and development.

 

INFORMED CONSENT FOR COUNSELING SERVICES PROVIDED BY
GREG HALL, MSEd, LPC, NCC, DCC and CHRISTIAN COUNSELING SERVICES, NFP

Free Screening

You must complete and submit the APPLICATION & SCREENING form. I will review the information that you provide and make recommendations for treatment based on your expressed needs. I will be happy to discuss my recommendations with you prior to scheduling any sessions.

Free Secure Email

I strongly suggest that you sign up for a free email account with HUSHMAIL. This service meets the standards for confidentiality.

Client Confidentiality

While under most circumstances all communication between the client and the counselor is confidential, Illinois State law mandates the reporting of actual and/or suspected child or elder abuse to the appropriate agency. It has also been upheld that if an individual intends to take harmful or dangerous action against another, it is the counselor’s duty to warn the person and/or family of the person who is likely to suffer the results of harmful behavior. Similar actions are taken with clients who may have suicidal thoughts and/or desires. Every reasonable effort will be made to appropriately resolve these issues or to notify the client before such a compromise of the client-counselor relationship is made.

Please note that texting and the use of my mobile phone number is acceptable for appointments and housekeeping issues only. Confidentiality cannot be guaranteed on mobile phones. All Computer files and email should use encryption software. I will communicate with you by HUSHMAIL, an encrypted email service that meets HIPPAA standards (Health Insurance Portability Accountability Act 1996). Hushmail allows me to receive and reply by email in a manner that protects your confidentiality.

Consent for Treatment

You give permission to Greg Hall, MSEd, LPC, NCC, DCC and Christian Counseling Center, to provide outpatient counseling for yourself and/or your child(ren). You understand that you will be treated with respect and honesty throughout the counseling process.

Treatment Risks

You are expected to benefit from treatment, but there are no guarantees. Outpatient counseling does not have significant risks. Maximum benefits will occur with regular attendance and work done between sessions. You should understand that you may feel temporarily worse while in treatment while addressing difficult issues.

Treatment Plan Participation

During your first session and throughout the counseling process, we will develop and review your treatment plan. The treatment plan will address the therapeutic objectives and possible outcomes of treatment. Please be sure to ask any questions about the therapeutic process, risks, concerns, or questions about my expertise in using therapeutic tools and techniques. You have the right to ask about other treatments for your issues as well as the risks and benefits. If you could benefit from a technique or treatment that I do not and/or am unable to provide, I have an ethical obligation to assist you in obtaining those treatments.

Telephone & Emergency Procedures

If you need to contact me between sessions to alert me of an emergency, please call/text my cell phone (618) 925-3714 and leave a message. I will return your call as soon as possible. If you need immediate assistance, please call the emergency National Suicide Hotline at 800-784-2433 or dial 911. If a life-threatening crisis should occur, you agree to contact a crisis hotline, call 911, or go to a hospital emergency room.

Accountability: Living Life Above Reproach - I Timothy 3:1-7

Scripture requires us to live our life above reproach. We request that ladies bring another person with you to your counseling session. We will be happy to provide comfortable accommodations for them while you are in your session. Children and minors should be accompanied by a parent or legal guardian.

Client Fees for Services

Current client fee rates are published on the website and posted in my office. I do my best to keep my professional counseling fees as low as possible. Clients are expected to pay fees as the services are rendered. I am able to accept cash, checks and credit/debit cards. Office sessions are purchased in 45-50 minute increments. Distance Counseling Sessions have several time options. Therapeutic email exchanges can be purchased one at a time or as a package.

Termination of Services

You have the right to terminate the therapeutic relationship at any time that you desire without fault. Please be reminded that you are financially responsible for any/all counseling services and for any unpaid balance on your account.

Appointment Cancellation

Please be respectful of your time as well as mine. Last minute cancellations should happen only in an extreme emergency. A minimum of 24-hour notice is required for re-scheduling or canceling an appointment. Unless we reach an agreement in advance, the full fee will be charged for sessions missed without such notification. Failing to cancel may be a missed opportunity for someone else to take advantage of the session time.

Limitations Regarding Distance (Online) Therapy

You should be aware that distance therapy requires an understanding that significant differences exist as compared to in-person sessions. These include differences in interactions, lack of visual and auditory cues, and other body language indicators that are helpful in establishing rapport and understanding. Please note that telephone/online counseling is not appropriate if you are experiencing a crisis or you have suicidal and/or homicidal thoughts. If a life-threatening crisis should occur, you agree to contact a crisis hotline, call 911 or go to the emergency room to seek appropriate support and care.

Third Party Billing/Insurance

I do not participate on insurance panels as either a preferred or out-of-network provider. I made this decision due to potential risks to client confidentiality with diagnosis and reports, and unreasonable administrative costs and time involved when dealing with insurance companies. I will not communicate with client’s insurance companies at any time for any reason.

Litigation Limitation

Your therapeutic experience may include your disclosure of highly confidential information. It is agreed that should you be engaged in a legal proceeding (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.) neither you (client) nor your attorney, nor anyone else acting on your behalf will call on me to testify in court or at any other proceeding, nor will a disclosure of your clinical records be requested.

Disputes, Complaints & Ratings

I pray that you will bring any concerns, complaints or disputes to my attention. I am unable to resolve an issue that I am unaware of or have had the opportunity to address. Please feel free to confront any behavior that you deem inappropriate. My prayer is that I reflect Christ in my practice but am reminded daily of my human nature. Please help me maintain accountability with you. I do not seek testimonials, ratings, or endorsements from you as my client. Asking for a testimonial from you is an unethical practice in my profession. If you do choose to write something on a business review site, please keep in mind that you may be sharing personally revealing information in a public forum.

Office Hours

By appointment only – please call 618 925-3714 to schedule an appointment. I am unable to schedule an appointment by text message or email.

Client Rights & Responsibilities
  • You have the right to care and treatment that respects your personal dignity and privacy regardless of race, religion, sex, age, and/or handicapping conditions.
  • You have the right to be informed of the cost of services rendered to you.
  • All services offered through Christian Counseling and Family Services are available to you regardless of your source(s) of support.
  • Your clinical records are confidential and cannot be released to anyone without you or your guardian’s written consent unless there is a court order or subpoena.
  • You have the right to an individualized treatment plan and to participate in the formation of that plan.
  • Upon written request, you have the right to review your current clinical records, under the supervision of your counselor.
  • You have the right to treatment in an environment that is the least restrictive.
  • You have the right to refuse treatment or any specific treatment procedure and a right to be informed of the consequences resulting from a refusal of treatment or of a treatment procedure.
  • You have the right to request and/or to be informed of alternate treatments available.
  • If you have any concerns or complaints regarding your treatment, you have the right to communicate your concerns directly to your counselor and/or the counselor’s immediate supervisor.
  • You have the right to confidentiality of HIV/AIDS status and testing.

APPLICATION FOR COUNSELING SERVICES

Please note that all information you disclose is confidential. This information will be used for your free screening. All responses are voluntary – please provide as much detail as your comfort level permits. You can expect a response from me within 24 hours of submitting your information.

Please note – I DO NOT provide drug/alcohol treatment. You must seek services from a licensed treatment program.

INFORMED CONSENT VERIFICATION

Submission of the Application For Counseling Services form indicates that you have read, understand, and agree to the policies specified in the Informed Consent for Counseling Services provided by Greg Hall, MSEd., LPC, NCC, DCC and Christian Counseling Services, NFP.
I have read and agree to all of the above:
Preferred Contact Methods – I give Greg Hall permission to contact me and/or leave a message using the following:
Emergency Contact - who do you want me to contact in case of an emergency?
Referral Source: How did you find out about Christian Counseling Center and/or Greg Hall?
Who will be participating in the counseling services? (Please list name and ages of participants)
What type of counseling format would you like to use? (You may choose multiple formats)



Please tell me about your family and other relationships where appropriate. Are there any family issues I should know about?
Please tell me about your marital history.
Please tell me about your medical history.
Please tell me about any previous counseling.

Please tell me about your educational history. How far have you gone in school? Did you have any educational issues?
Please tell me about your military history.
Please tell me about your legal history.
Please tell me about your use of drugs and alcohol. Please estimate how much and how often you use the following: