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Professional Disclosure Statement

Of

Linda T. Curtis, MA, ABD

 

Licensed Professional Counselor

 Limited Licensed Psychologist

 

This form was developed for you, my client, to provide information regarding your rights as a client and my professional practice of information.  You are encouraged to read and understand information. You are also encouraged to ask me any questions regarding this material.

 

PERSONAL STATEMENT

I am dedicated to providing all people, regardless of sex, age, race, religion, or national origin, with a service involving application of clinical counseling principles, methods, or procedures for the purpose of achieving social, personal, career and emotional development.  My goal is to promote and enhance healthy self actualizing and satisfying lifestyles.  I agree to respect the rights of those persons seeking my assistance, and make reasonable efforts to ensure that my services are used appropriately.

 

CONFIDENTIALITY

I have a primary obligation to respect the confidentiality of my client and the information obtained during the clinical sessions.  I will reveal such information to others only with the consent of the person or the person’s legal representative, except in those unusual circumstances in which not to do so would result in a clear danger to the person or two others.  There are certain situations in which information about clients may be released with or without their permission. The situations are as follows:

 

1. Where children are physically abused, neglected, or sexually abused, the proper authorities (e.g., police, Child Protective Services, Family Independence Agency) must be notified.

 

2. In an emergency situation when the client or others may be in danger, as with suicide or homicide, confidentiality may be broken.

 

FEE SCHEDULE

The fee for a 1-hour session is $120.00.  There could be other charges, for example, reports, lengthy phone calls and interpretation of evaluation instruments administered to assess an individual’s aptitudes, interests, attitudes, abilities, achievements, and personal characteristics for development purposes.  Payment is expected at time of service, unless other arrangements are specifically made.

 

EDUCATION

I received my Master of Arts degree in Community and Agency Counseling from Wayne State University in Detroit, Michigan on December 18, 1997.   I received my Bachelor of Science degree in Psychology from Midwestern State University in Wichita Falls, Texas on May 13, 1995. I completed a two-year post-graduate specialization in Mental Health/Psychological Testing from Oakland University in May 2001.  I hold an A.B.D. in Clinical Psychology from Walden University and expect my Ph.D. by December 2010.

 

EXPERIENCE

I am currently a therapist providing professional client services including individual and group counseling, treatment planning and development, diagnostic testing and assessment procedures, family consultation, case consultation and crisis intervention. My professional experiences include rendering personal and career counseling services for general and special student populations including abused and emotionally, physically, and academically impaired adult and teenage students.

 

Department of Labor and Economic Growth

Bureau of Commercial Services

PO Box 30018

Lansing MI 48909

Enforcement Division (517) 241-9202

License Verification (517) 241-9254

 

Email:  lcurtis@beyondexpectationll.com lcurtisinfo@fitnesscentre.web

Professional Disclosure Statement