Informed Consent (Dayna Osborne)

At our Twin Oaks Counseling we believe counseling is a process whereby a counselee seeks to resolve personal, interpersonal, and / or spiritual difficulties with the assistance of anotehr caring individual.  Your counselor will bring to the sessions his or her professional knowledge and experience, but the ultimate responsibility for growth and change rests with the client.

you are invited at an time to ask questions about your counselor, his or her methods, the direction the counseling is headed, and the estimated duration of counseling.

As a client of Twin Oaks Counseling, it is your right to have the content of your therapy sessions held in confidence with these exceptions in which we are mandated to report:
1.)  If client signs a release form for us to divulge any or all information>
2.)  If client intends suicide.
3.)  If client intends to harm another person or persons.
4.0  In the case of child, elder, or handicapped abuse or neglect.
5.)  In response to a subpoena issued by a court of law.

Dayna Osborne is a Licensed Professioan Counselor (LPC) within the State of Missouri, and a National Certified Counselor (NCC).  Dayna has two years of post graduate marriage and family training with Menninger, and over 17 years of experience as a Licensed Professional Counselor.

Counseling sessions typically last 50 minutes and Dayna's fee is $65.00 per session.  We would prefer payment in the form of a check made payable to TOPC with the initials C.C. (Counseling Center) on the memo line.  Please give your payment to Dayna before your session begins.

If at any time you determine your insurance company will reimburse you for the fee you have paid, ask Dayna for a form you can send to your isurance company.  This is entirely your responsibility.  We do not bill for services, and if youd esire to receive a receipt for payment please ask for one.

If you need to change or cancel an appointment, please notify us at least 24 hours prior to your appointment.  Failure to do so will result in you being charged for the full amoount for the sessions. If the client is a minor, please complete the Consent For Treatment Of A Minor form.

I understand and agree to abide by the above policies.

_________________________________  _______________________________
                      Signature                                                                             Print

Counselor:___________________________________Date:__________________

                                    1230 Big Bend Road, Ballwin, Missouri 63021
                                                            636-861-1870

Last Published: March 11, 2008 10:33 PM
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9:00 am    Sunday School
Adult, Youth, Children's
9:45 am     Fellowship Time
10:10 am   Worship Service

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First Sunday of the month

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Second Sunday of the month


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Twin Oaks
Presbyterian Church
1230 Big Bend Rd.
Ballwin, MO 63021

636.861.1870
636.861.1613 fax
 

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