Firelight Wellness Coaching and Counseling
Liability and Confidentiality Agreement
This Liability and Confidentiality Agreement ("Agreement") is entered into by and between Firelight Wellness Coaching and Counseling, and the undersigned client ("Client") for the purpose of defining the terms under which counseling services will be provided.
1. Confidentiality
Confidentiality is essential in creating a safe and effective counseling environment. I, the undersigned counselor, agree to maintain the confidentiality of any information shared during sessions, including personal, medical, or psychological details, except under the following circumstances:
If there is an imminent risk of harm to the client or others, where disclosure is required to protect life and safety.
If there is a legal obligation to disclose information, such as in cases of child abuse or neglect, or in response to a court order.
If the client consents in writing to the release of information to specified individuals or organizations.
By signing this form, the client agrees to the conditions outlined above and understands the limitations of confidentiality.
2. Client’s Consent
The client consents to participate in counseling sessions, understanding that these sessions are designed to explore and address personal issues, emotions, or mental health concerns. The client is free to withdraw from therapy at any time, though continued participation is strongly encouraged for the best therapeutic outcome.
3. Limitations of Liability
While the counselor will use all professional expertise to assist the client in their mental health or personal development, counseling may involve challenging emotions and processes. As such, the client understands and agrees to the following:
The counselor will not be held liable for any actions taken by the client, including but not limited to personal decisions or consequences arising from counseling services.
The client agrees that counseling services provided by Firelight Wellness are not a substitute for medical, legal, or psychiatric treatment, and the counselor is not liable for any medical, legal, or psychiatric issues or decisions arising outside the scope of the counseling session.
The counselor is not liable for any damages or outcomes resulting from the client’s choices or actions outside the context of the counseling relationship.
4. Emergency Situations
If the client is experiencing an emergency or crisis outside of regular session hours, it is the client's responsibility to seek immediate help from appropriate professionals, such as calling 911 or visiting the nearest emergency room.
5. Payment and Cancellations
The client agrees to the following payment terms for counseling services:
The client agrees to notify the counselor of any cancellations at least 24 hours in advance. Cancellations within this time frame or failure to attend a session will result in a 50% charge for the missed session and may require prepayment to book future sessions.
6. Consent to Use Data for Record-Keeping
The client understands and agrees that personal information, session notes, and other relevant data will be stored securely and used for internal record-keeping, treatment planning, and professional development. Such records will not be shared without the client’s consent unless required by law or ethical obligations.
7. Agreement to Participate
By signing this Agreement, the client confirms that they have read, understood, and agreed to the terms outlined above. This consent is valid for a one year (from the date signed) duration of the counseling relationship, unless otherwise revoked by the client in writing.
Counselor Signature: ________________________
Date: ____________________________________
Session Date(s): ____________________________
Client Details (your details):
