CLIENT RIGHTS AND RESPONSIBILITIES/INFORMED CONSENT

METHOD OF COUNSELING: ______(initial)

Your counselor’s method of counseling is based on biblical principles. He is a Christian counselor whose beliefs shape the counseling process. He is also able to work with those who do not share his beliefs. His desire is to create a context in which every person coming through the doors will find a safe and loving place to experience the grace and truth of the gospel. Your counselor relies on the authority of God's word, the sufficiency of God's promises, the presence of the Holy Spirit, and the power of the gospel to change lives.

BTM concentrates on “triage”, short-term counseling designed to quickly stabilize, shift the momentum with some critical decisions and develop a longer term life plan strategy. BTM will occasionally offer longer term counseling where it is an appropriate fit. Otherwise, referrals will be offered to best suit the agreed upon next steps.

NOTE: BTM provides counsel for individual males, marriages, families and teams/organizations / churches. We do not offer long term counsel for individual females, but will provide strong referrals for those who do.

GOALS, RISKS, AND BENEFITS: ______(initial)

There is always risk of emotional side effects from counseling. Sometimes symptoms worsen before they get better. Often counseling brings up painful emotions. Our goal is to confront these issues and emotions together. Other types of counseling may also be appropriate in your situation. Together we will determine if and what other types of counseling are appropriate.

LENGTH OF COUNSELING: ______(initial)

Counseling sessions are 60-75 minutes in length. If you are late for any reason, you will receive the remainder of your scheduled time, but you will not be given a full 60-75 minutes. The number of sessions needed depends on a variety of factors and can be discussed more fully with the counselor.

FEES: ______(initial)

The professional fee for these counseling services is generally $125** per session. Payment is due the day of service. Talk with your counselor about payment options if there is difficulty paying for these services.

**This fee represents a 20% discount to the market average, given because we do not take insurances.

CANCELLATION POLICY: ______(initial)

Your appointment time is reserved exclusively for you. You will be charged and expected to pay the full session rate for any and all appointments for which you do not show up or for which you do not provide 24-hour notification of cancellation.

OUR RELATIONSHIP: ______(initial)

The relationship between you and your counselor is professional rather than personal in nature. It is important to keep the parameters of this relationship clear, therefore personal phone calls and social interaction are inappropriate. Please do not offer gifts, ask for written references, or expect to relate in any way other than in the professional context. Service is best provided if counseling sessions concentrate exclusively on your concerns.

Visitor Waiver & Acknowledgement: ______(initial)

I acknowledge that I am a visitor on the property of 13403 George Road, San Antonio TX 78230. This property is a special place, originally a private residence and used as a special retreat type setting now. The architecture of the home and the setting of the property is quite unique. I take full responsibility to park in appropriately designated areas, be cognizant of the floor plan and features of the building, avoid trespassing into private areas of the property and avoiding any undue risk while participating in meetings at the facility. I indemnify (hold harmless) the owners, operators, staff, agents and affiliates of this building for any personal injury I might sustain while on the premises. I am participating in any gathering at this facility at my own risk.

EMAIL, TEXT, PHONE & SKYPE CONSULTATIONS: ______(initial)

Your counselor does not provide counseling via email, text or phone. All email, text and phone correspondence should be kept to a minimum and will not involve the giving of advice or counsel, nor should it be expected to address sensitive issues. Online Skype sessions can be made available when appropriate.

STATEMENT OF CONFIDENTIALITY: ______(initial)

All communication between the client and counselor becomes part of the clinical record. In accordance with legal requirements, adult client records may be disposed of five years after the file is closed; minor client records are disposed of seven years after the client’s 18th birthday.

While most communication between a client and counselor is confidential, the following limitations and expectations do exist:

  • The counselor determines if the client is a danger to himself or someone else.
  • The client discloses abuse, neglect, or exploitation of a child, the elderly, or a disabled person.
  • The client discloses sexual contact with another mental health professional.
  • The counselor is ordered by a court to disclose information.
  • The counselor is otherwise required by law to disclose information.

In the case of marriage, couples, or family counseling, there is limited confidentiality, meaning that confidentiality belongs to the relationship and not to the individual. Therefore, the clinical record belongs to the relationship, not to the individual. This means that in the case of written consent all parties need to provide consent in order for the information to be released.

REFERRALS: ______(initial)

Should the client and/or counselor believe that a referral is needed, alternatives will be provided. A verbal exploration of alternatives to counseling will also be made available upon request. The client will be responsible for contacting and evaluating those referrals and/or alternatives.

EMERGENCIES: ______(initial)

The client can contact the counselor at 210-601-5211 or . If the client is unable to reach the counselor in a timely manner, he/she should contact a physician, a local emergency room or the local police department when necessary and appropriate (dialing 911). It is the client’s responsibility to seek the appropriate resources in emergency situations.

I understand that my counselor does not provide 24-hour emergency crisis counseling. Should I experience an emergency requiring immediate mental health attention, I will immediately access help via a 911 emergency call or go to the emergency room.

Dave Galbraith’s professional experience and credentials can be seen at

Please verify by signing below that you have read through and understood the Informed Consent. If you have any questions or concerns, please discuss them with your counselor before signing.

______(Client Signature) ______(Date)