Online Intake

STATEMENT OF UNDERSTANDING AND AGREEMENT ON CONFIDENTIALITY:
Information you provide to a Perspectives counselor during a counseling session is confidential. Perspectives will not disclose the information without your written consent except as set forth below:

1. Perspectives may disclose confidential information if it concerns abuse or neglect of a child, dependent adult, disabled person, or elderly person.
2. Perspectives may disclose confidential information if the counselor determines that disclosure is reasonably necessary to prevent a direct threat to the health or safety of yourself or others.

Perspectives will not disclose other confidential information unless it falls within exceptions 1 - 2 above or if you give your written permission to disclose it.

By accepting below, I acknowledge that I have read and understand the above statement and that I agree to proceed pursuant to the terms set forth above.