*Please provide a copy of the custody agreement.
For therapy to be effective, confidentiality must be honored. No information will be shared with a party outside of the office without your written consent. Additionally, information your child shares with their
therapist in his/her private sessions will be held confidential. However, the goals and progress of the
counseling may be shared with you, any other legal custodial parent or guardian. By law, confidentiality
must be breached if a therapist or therapist intern suspects that any minor is being or has been abused, if a person plans to physically harm another person, or if a person plans to harm him/herself. Additionally,
breaching of confidentiality will occur if a therapist or therapist intern hears that an elder or dependent
adult is being or has been abused.