Notices and Forms

This is where you will find all of our notices and forms made available for your convenience. Please look below for your options.

Client Rights and Responsibilities

Client Rights

As a client, you have the right to:

▪ Select a professional counselor who meets your needs.

▪ Receive specific information about your counselor’s qualifications, including education, experience, national counseling certifications, and state licensure.

▪ Obtain a copy of the code(s) of ethics your counselor must follow.

▪ Receive a written explanation of services offered, time commitments, fee scales, and billing policies prior to receipt of services.

▪ Understand your counselor’s areas of expertise and scope of practice (e.g., career development, adolescents, couples, etc.).

▪ Ask questions about confidentiality and its limits as specified in state laws and professional ethical codes.

▪ Receive information about emergency procedures (e.g., how to contact your counselor in the event of a crisis).

▪ Ask questions about counseling techniques and strategies, including potential risks and benefits.

▪ Establish goals and evaluate progress with your counselor.

▪ Request additional opinions from other mental health assessment professionals.

▪ Understand the implications of diagnosis and the intended use of psychological reports.

▪ Obtain copies of records and reports.

▪ Terminate the counseling relationship at any time.

▪ Share any concerns or complaints you may have regarding a professional counselor’s conduct with the appropriate professional counseling organization or licensure board.

Client Responsibilities

In order for your counselor to provide the highest quality of services, it is important that clients:

▪ Adhere to established schedules. If you must miss an appointment, contact your counselor as soon as possible.

▪ Pay your bill in accordance with the billing agreements.

▪ Follow agreed-upon goals and strategies established in sessions.

▪ Inform your professional counselor of your progress and challenges in meeting your goals.

▪ Participate fully in each session to help maximize a positive outcome.

▪ Inform your counselor if you are receiving mental health services from another professional.

▪ Consider appropriate referrals from your counselor.

▪ Avoid placing your counselor in ethical dilemmas, such as requesting to become involved in social interactions or to barter for services.

Remember that a counselor who meets the needs of one person may not meet the needs of another.

If you are dissatisfied with the services of your counselor:

▪ Express concerns directly to the counselor, if possible.

▪ Seek the advice of the counselor’s supervisor if the counselor is practicing in a setting where he or she receives direct supervision.

▪ Terminate the counseling relationship if the situation remains unresolved.

▪ Contact the appropriate state licensing board, national certification organization, or professional association if you believe the counselor’s conduct to be unethical.

Derechos del Cliente

Como cliente, tienes el derecho de:

Elegir un consejero profesional que satisfaga tus necesidades.
Recibir información específica sobre las calificaciones de tu consejero, incluyendo educación, experiencia, y licencias estatales.
Obtener una copia del (los) código(s) de ética que tu consejero debe seguir.
Recibir una explicación por escrito de los servicios ofrecidos, compromisos de tiempo, y de aumentos o cambios de pagos antes de recibir los servicios.
Entender las areas de especializacion de tu consejero (por ejemplo, desarrollo professional, adolescentes, parejas, etc.).
Hacer preguntas sobre la confidencialidad y sus límites según lo especificado en las leyes estatales y los códigos éticos profesionales.
Recibir información sobre los procedimientos en caso de una emergencia (por ejemplo, cómo contactar a tu consejero en caso de una crisis.).
Hacer preguntas sobre técnicas y estrategias de tu consejero, incluyendo los posibles riesgos y beneficios del tratamiento.
Establecer metas y evaluar el progreso con tu consejero.
Solicitar opiniones adicionales de otros profesionales de la evaluación de tu salud mental.
Comprender las implicaciones del diagnóstico y el uso previsto de los informes psicológicos.
Obtener copias de registro e informes.
Terminar la relación de consejería en cualquier momento.
Compartir cualquier inquietud o queja que pueda tener con respecto a la conducta de un consejero profesional con la organización profesional de consejería adecuada o la junta de licencias.

Responsabilidades del Cliente

Para que su consejero pueda dar servicios de la más alta calidad, es

importante que los clientes:

Se adhieran a los horarios establecidos. Si debe faltar a una cita, comuníquese con su consejero lo antes posible.
Paguen su factura de acuerdo con los acuerdos de facturación.
Sigan las metas y estrategias acordadas establecidas en las sesiones con su consejero.
Informarle a su consejero profesional sobre su progreso y desafíos en el cumplimiento de sus metas.
Participar por completo en cada sesión para poder maximizar un resultado positivo.
Informarle a su consejero si está recibiendo servicios de salud mental en otro establecimiento o otro profesional.
Considerar las referencias apropiadas de su consejero.
Eviten colocar a su consejero en dilemas éticos como solicitor involucrarse en interacciones sociales o intercambiar servicios.

Recuerda que un consejero que satisface las necesidades de una persona puede

no satisfacer las necesidades de otra.

Si no está satisfecho con los servicios de su consejero:

Exprese sus preocupaciones directamente al consejero, si es possible.
Busque el consejo del supervisor del consejero está practicando en un entorno donde recibe supervisión directa.
Termine la relación de consejería si la situación permanece sin resolver.
Póngase en contacto con la junta de licencias del estado correspondiente, la organización de certificación nacional o la asociación profesional si cree que la conducta del consejero no es ética.

Grievance Policy

PROCEDURE

As the goal of Phoenix Rising Counseling, LLC is to give sufficient local authority to meet service user needs, complainants will be encouraged, but not required to work through the lines of authority within the organization.

To provide maximum support to the staff-service user and community member relationship, the complaint resolution process begins with the involvement of the staff person who provided service, unless this is not in the best interests of the service user or community member.

STEP 1: Receiving a Complaint

a. If the person providing service receives the complaint the service user or community member should be offered the earliest opportunity to discuss their concern(s).

b. If the complaint is received by any staff member or volunteer of the organization other than the person providing service the service user or community member should be directed to the person providing service with an explanation of Phoenix Rising Counseling, LLC policy. If the complainant is reluctant to speak directly to the person providing service they should be referred to that person’s immediate manager. The person providing service should be alerted to the existence of the complaint.

c. In hearing a complaint the person providing service may decide to involve or consult their manager at any stage. This option should be taken if the service user brings a friend or advisor.

d. If the complaint is handled to the mutual satisfaction of the complainant and the person providing service, the complaint and resolution is documented on the Complaint Form and a copy is forwarded to the manager of the person providing service and the department director.

STEP 2: Discussion with a Manager

a. If the person providing service is unable to resolve a complaint, the complainant is offered the opportunity to speak with the manager.

b. The preferred method is to have the manager call the service user or community member. This affords the staff person the opportunity to discuss the matter with the manager prior to any further action or outreach to the complainant.

c. The manager calls the service user or community member as soon as possible after consulting with the person who provided the service.

d. If a service user or community member calls a manager to complain about the person providing the service or about the service provided, the manager should hear the complaint, but offer no action without discussing the matter with the staff person involved.

e. From the point a manager takes a call from a service user or community member or calls a complainant about a complaint, a meeting between the manager and complainant should be offered within five working days.

f. The staff person(s) and manager should jointly plan the response to the service user’s or community member’s complaint. Whenever possible the plan should support the integrity of the service user/community member/staff relationship and unless clearly contraindicated, the staff person will be present at any meeting between the manager and complainant.

g. The role of the manager is to resolve the matter to the satisfaction of the service user or community member and staff person(s) or, failing this, to inform the complainant of their right to seek resolution through a meeting with the Director.

h. A letter must be sent to the service user or community member within two weeks of the meeting. The Director of Programs and Services is informed of the complaint and the resolution or lack of resolution.

STEP 3: Meeting the Department Director (If applicable)

a. If the service user or community member is not satisfied with the response from the manager the initiative for carrying the complaint to the Director rests with the complainant.

b. The service user or community member should be informed of the name and phone number of the Director if she/he wishes to pursue the complaint. The Director is alerted immediately if a call is anticipated and a copy of the completed Complaint Form is provided.

c. If requested, the Director will meet with the service user or community member within two weeks of receiving the request.

d. Prior to this the Director will contact the manager and the staff person and seek any necessary consultation. Whenever possible the Director will attempt to involve the staff and manager in the planning process and may invite one or both to the meeting.

e. The Director will attempt to resolve the problem with the service user or community member. Whatever the outcome, the Director will inform the complainant by mail not more than two weeks after the meeting.

f. The Director will inform the Executive Director of the meeting with the service user or community member and the outcome.

STEP 4: Meeting the Executive Director/Owner

a. If the service user or community member is not satisfied with the response from the Director the complainant may take the complaint to the Executive Director and should be informed of the name and phone number of the

Executive Director.

b. The Executive Director should be alerted immediately if a call is anticipated and a copy of the completed Complaint Form should be provided.

c. If requested, the Executive Director or her or his designate will meet with the service user or community member within two weeks and attempt to resolve the matter.

d. Prior to this, the Executive Director will inform the Director, manager and the staff person(s) of the approach and seek any necessary consultation.

e. Whenever possible the Executive Director will involve the staff person(s) and manager in the planning process and may invite one or all of them to the meeting.

f. Prior to the meeting the Director will ensure that a letter bearing his/her signature is sent to both the service user or community member and the Executive Director outlining the complaint and all the steps taken to resolve the complaint.

g. Within two weeks of meeting the service user or community member, the Executive Director or her/his designate will send a letter to the complainant setting out any agreement reached, or failing this, the Executive Director's decision regarding the complaint. The person(s) providing the service and those at the first level of authority will be kept informed throughout all attempts to resolve complaints. In instances where there is an allegation of criminal or serious ethical breach of conduct by Phoenix Rising Counseling, LLC personnel, the Executive Director may waive the requirement to inform personnel until legal and/or police advice is sought and may continue to refrain from informing the person during the course of an investigation providing there is no breach of a legal or contractual standard. While every attempt should be made to achieve a positive resolution with the complainant, the integrity of Phoenix Rising Counseling, LLC policies and the integrity and safety of Phoenix Rising Counseling, LLC personnel and other service users or community members must be maintained.

Greivance Form PDF