THE GREATEST GIFT YOU CAN GIVE ANOTHER IS THE PURITY OF YOUR ATTENTION RICHARD MOSS CLINICAL COUNSELING SERVICES THE COMMUNITY COLLEGE OF BALTIMORE

Size: px
Start display at page:

Download "THE GREATEST GIFT YOU CAN GIVE ANOTHER IS THE PURITY OF YOUR ATTENTION RICHARD MOSS CLINICAL COUNSELING SERVICES THE COMMUNITY COLLEGE OF BALTIMORE"

Transcription

1 THE GREATEST GIFT YOU CAN GIVE ANOTHER IS THE PURITY OF YOUR ATTENTION RICHARD MOSS CLINICAL COUNSELING SERVICES THE COMMUNITY COLLEGE OF BALTIMORE COUNTY

2 WHY COUNSELING IN A COLLEGE ENVIRONMENT Students are encouraged to seek counseling for personal, career, social and academic concerns. To help aid students create a stable environment that allows them to learn and grow.

3 Counseling services and development workshops are designed to enhance the personal and interpersonal development of students and to help students achieve their academic goals.

4 CLINICAL COUNSELING SERVICES These services include: Individual Counseling Group Counseling Relationship Counseling Consultation with faculty/staff Depression and anxiety screenings and assessments Crisis Intervention Stress management Trainings, Seminars, and Workshops

5 CLINICAL COUNSELING Services are: Free Short term Confidential Available by appointment or walk-in

6 CONFIDENTIALITY Counselors will neither confirm nor deny that a student is visiting the counseling center No information is shared outside of the counseling center staff without written consent of the student This is true whether you are a parent, friend, or professor. information will not be disclosed

7 LIMITATIONS TO CONFIDENTIALITY The therapist believes there is intent to harm oneself. The therapist believes there is intent to harm someone else. The therapist receives a court order.

8 WHAT HAPPENS DURING THE COUNSELING PROCESS I. Build Rapport II. III. IV. Assess the Problem Set Goals w/ Client Initiate Intervention V. Termination, Referral, Follow-up

9 COUNSELING IS NOT A forum where the counselor will solve the clients problems Long Term Psychotherapy Friendship

10 BEHAVIORS THAT MAY SUGGEST COUNSELING INTERVENTION Repeated requests for special consideration, extensions, etc. Unusual or exaggerated emotional responses. Excessive absences, especially if attendance was previously consistent. Perfectionism, procrastination, or excessive worrying. Markedly changed patterns of interaction (avoiding, participation, or dominating discussion). Overtly discussing or hinting that suicide is a current and viable option.

11 MAKING THE REFERRAL Address your observation(s) and concern(s) to the student. Suggest Counseling Services to the student, if appropriate. Let the student know that it is not necessary to know exactly what is wrong in order to seek assistance. Assure the student that seeking help does not necessarily mean their problems are unusual or extremely serious. Be frank about your own limits of time, energy, training, and objectivity. Offer to walk them to a counselor or to assist in making the call to Counseling Services. If appropriate, call a counselor for consultation or to make a referral.

12 REFERRALS Internal referrals include: Academic Advisement Career Services Tutoring Center Writing Center Math Center Referrals will be made to community agencies as needed These agencies include: Department of Social Services Vocational Rehabilitation Employment Security Commission (ESC) United Way Others

13 Counseling SUMMARY Addresses issues of wellness and personal growth. Applies mental health, psychological, and/or human development principles. Uses cognitive, affective, behavioral or systematic intervention strategies. Competency. Collaborative with student. A safe and open environment for self-expression.

14 CLINICAL COUNSELING SERVICES STAFF Heather Griner, L.C.P.C. (Licensed Clinical Professional Counselor) Post Masters Certificate Johns Hopkins University M.Ed. Loyola College in Maryland Deb Hollander, L.C.P.C. (Licensed Clinical Professional Counselor) M.S. Loyola College M.F.A. Maryland Institute College of Art Larry Messier, PhD, Psychologist Ph.D. - University of Maryland, College Park M.A. - Towson University Marissa Southwell, L.C.P.C. (Licensed Clinical Professional Counselor) Ph.D. candidate - Loyola University in Maryland M.S. - Loyola University in Maryland Karen Wallace, PhD, L.C.P.C. (Licensed Clinical Professional Counselor) Ph.D. University of Maryland, College Park M.Ed. University of Maryland, College Park

15 COUNSELING SERVICES CAMPUS LOCATIONS Catonsville Campus Building K Room 200 Dr. Lawrence Messier and Dr. Karen Wallace Dundalk Campus Building A Room 100 Heather Griner Essex Campus Building A Room 220 Deb Hollander and Marissa Southwell

16 COUNSELING SERVICES For further information regarding our services, please go to our website at: and click the link current student, then click view all, then go to services, then click on counseling Portions of this power point can be referenced at ; and

SUMMARY OF QUALIFICATIONS EDUCATION. Post Graduate Studies in Counseling (12cr.) Johns Hopkins University, Baltimore, Maryland

SUMMARY OF QUALIFICATIONS EDUCATION. Post Graduate Studies in Counseling (12cr.) Johns Hopkins University, Baltimore, Maryland ANDREA G. BATTON, LCPC The Maryland Anxiety Center 1122 Kenilworth Drive, Suite 313A Towson, Maryland 21204 Phone: 443-921- 2929 Fax: 443-921- 2919 www.marylandanxietycenter.com SUMMARY OF QUALIFICATIONS

More information

Best Practices Manual For Counseling Services. A Guide for Faculty & Staff

Best Practices Manual For Counseling Services. A Guide for Faculty & Staff Best Practices Manual For Counseling Services A Guide for Faculty & Staff 7/2014 Table of Contents Purpose of the Best Practices Manual for Counseling Services.3 General Guidelines on Responding to Concerns

More information

Faculty/Staff Referral Guide for Students in Crisis

Faculty/Staff Referral Guide for Students in Crisis Counseling Services Faculty/Staff Referral Guide for Students in Crisis The purpose of this guide is to provide faculty and professional staff with information about counseling services, referral information,

More information

Disclosure Statement

Disclosure Statement Denver Christian School K-12 Counseling Center 3898 S Teller Street Lakewood, CO 80235 1. COUNSELOR INFORMATION Disclosure Statement The following is a disclosure statement for the counseling department

More information

Presented by: Cory Wallack, Ph.D., Counseling Center Sarah T. Solomon, M.S., Student Assistance. Division of Student Affairs

Presented by: Cory Wallack, Ph.D., Counseling Center Sarah T. Solomon, M.S., Student Assistance. Division of Student Affairs Presented by: Cory Wallack, Ph.D., Counseling Center Sarah T. Solomon, M.S., Student Assistance Division of Student Affairs Trends in college mental health Overview of Counseling Center services Overview

More information

Education. Clinical Experience

Education. Clinical Experience Kesia Constantine, Ph.D. Clinical Associate Professor Department of Applied Psychology New York University 246 Greene Street, room 709 New York, NY 10003 kesia.constantine@nyu.edu Ph.D. in Counseling Psychology

More information

School Counseling Programs and Services

School Counseling Programs and Services REGULATION Related Entries: IJA Responsible Office: Special Education and Student Services MONTGOMERY COUNTY PUBLIC SCHOOLS IJA-RA School Counseling Programs and Services I. PURPOSE A. To ensure that a

More information

Heather Gowin, MA, LPC

Heather Gowin, MA, LPC MANDATORY DISCLOSURE STATEMENT Name: DOB: Date: In accordance with Colorado State Law, the following information is provided to all persons entering or considering entering psychotherapy. I am a Licensed

More information

Student Learning Outcomes Report Counseling and Psychological Services

Student Learning Outcomes Report Counseling and Psychological Services Student Learning Outcomes Report Counseling and Psychological Services Through a campus-wide media campaign, students were invited to participate in an online mental health screening program that was accessed

More information

TIDELANDS COUNSELING CINDY STRICKLEN, M.S., I.M.F. LICENSE #61293 1411 Marsh Street Suite 105, San Luis Obispo, CA 93401

TIDELANDS COUNSELING CINDY STRICKLEN, M.S., I.M.F. LICENSE #61293 1411 Marsh Street Suite 105, San Luis Obispo, CA 93401 TIDELANDS COUNSELING CINDY STRICKLEN, M.S., I.M.F. LICENSE #61293 1411 Marsh Street Suite 105, San Luis Obispo, CA 93401 Minor Consent for Treatment and Service Agreement Welcome to Tidelands Counseling!

More information

Counseling and Consultation Services

Counseling and Consultation Services Counseling and Consultation Services ANNUAL REPORT EXECUTIVE SUMMARY 2010-11 A YEAR IN REVIEW INSIDE MESSAGE FROM THE DIRECTOR 1 MISSION STATEMENT 1 CCS STAFF INFORMATION 2 OUTREACH 2-3 CLIENT DEMOGRAPHICS

More information

CLIENT QUESTIONNAIRE

CLIENT QUESTIONNAIRE Leland E. McHatton, MFT Marriage Family Therapist 1430 East Avenue, Suite 4C 530.566.1212 Chico, California 95926 CLIENT QUESTIONNAIRE Client s Name: Spouse s or Parent s Name: Date of Birth: Date of Birth:

More information

Wray De Anda, Psy.D., PSY 25484 Licensed Clinical Psychologist 1940 W. Orangewood Ave, Suite-110 Orange, CA 92868 (714) 623-0997

Wray De Anda, Psy.D., PSY 25484 Licensed Clinical Psychologist 1940 W. Orangewood Ave, Suite-110 Orange, CA 92868 (714) 623-0997 Wray De Anda, Psy.D., PSY 25484 Licensed Clinical Psychologist 1940 W. Orangewood Ave, Suite-110 Orange, CA 92868 (714) 623-0997 Informed Consent & Agreement for Psychotherapy Services Effective July 7,

More information

Connections Counseling, L.L.C. Couple/Family s Personal Information

Connections Counseling, L.L.C. Couple/Family s Personal Information Name (s): SS#(indicate name): Home Address: Connections Counseling, L.L.C. Couple/Family s Personal Information DOBs/Ages: How were you referred? Specify names of which client for all questions below:

More information

Jerry M. Ruhl Ph.D. Clinical Psychologist (Texas #34359) 5200 Montrose Blvd. Houston, TX 77006

Jerry M. Ruhl Ph.D. Clinical Psychologist (Texas #34359) 5200 Montrose Blvd. Houston, TX 77006 Jerry M. Ruhl Ph.D. Clinical Psychologist (Texas #34359) 5200 Montrose Blvd. Houston, TX 77006 CELL (937) 684-7746 PLEASE USE THIS NUMBER TO SCHEDULE OR CHANGE APPOINTMENTS INFORMED CONSENT FOR TREATMENT

More information

TIDELANDS COUNSELING STACY GUISSE, PSY.D., MFT LICENSE #48134 1411 Marsh Street Suite 105, San Luis Obispo, CA 93401

TIDELANDS COUNSELING STACY GUISSE, PSY.D., MFT LICENSE #48134 1411 Marsh Street Suite 105, San Luis Obispo, CA 93401 TIDELANDS COUNSELING STACY GUISSE, PSY.D., MFT LICENSE #48134 1411 Marsh Street Suite 105, San Luis Obispo, CA 93401 Adult Consent for Treatment and Service Agreement Welcome to Tidelands Counseling! Tidelands

More information

SCHOOL COUNSELING MISSION STATEMENT

SCHOOL COUNSELING MISSION STATEMENT SCHOOL COUNSELING MISSION STATEMENT The mission of the counselors at Dexter High School is to provide high quality, comprehensive school counseling services to all students. Our program, as guided by the

More information

Bert Epstein, Psy.D.

Bert Epstein, Psy.D. Bert Epstein, Psy.D. 159 Kentucky Street Suite 3 Petaluma, CA 94952 707 242-1989 bert@drbertepstein.com CA License PSY 21404 Office Policies & Agreement for Psychotherapy Services Welcome. Your first visit

More information

Is There a Role for School Psychologists on College Campuses

Is There a Role for School Psychologists on College Campuses Is There a Role for School Psychologists on College Campuses JUDITH KAUFMAN, PH.D., ABPP FAIRLEIGH DICKINSON UNIVERSITY Where are they now? In a recent survey, less than 12% of colleges and universities

More information

The Field of Counseling. Veterans Administration one of the most honorable places to practice counseling is with the

The Field of Counseling. Veterans Administration one of the most honorable places to practice counseling is with the Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration

More information

Dale C. Godby, Ph.D., ABPP, CGP 6330 LBJ Suite 150 Dallas, Texas 75240 972-233-0648

Dale C. Godby, Ph.D., ABPP, CGP 6330 LBJ Suite 150 Dallas, Texas 75240 972-233-0648 Dale C. Godby, Ph.D., ABPP, CGP 6330 LBJ Suite 150 Dallas, Texas 75240 972-233-0648 Problems in love and work, as well as troubling symptoms like depression and anxiety, often lead people to seek therapy.

More information

Anna M. Trad, Ph.D., 1244 Clairmont Road, Suite 204 Decatur, GA 30030

Anna M. Trad, Ph.D., 1244 Clairmont Road, Suite 204 Decatur, GA 30030 Anna M. Trad, Ph.D., 1244 Clairmont Road, Suite 204 Decatur, GA 30030 PSYCHOLOGIST - PATIENT SERVICES AGREEMENT Welcome to my practice. This document (the Agreement) contains important information about

More information

GENESIS COUNSELING GROUP, S.C.

GENESIS COUNSELING GROUP, S.C. PSYCHOLOGY SERVICES CONTRACT Welcome to my practice. This document contains important information about my professional services and business policies. Please read it carefully and jot down any questions

More information

Michael S. McLane, Psy.D. Licensed Psychologist. Informed Consent to Treatment / Evaluation of a Minor Child. who was born on and who resides at

Michael S. McLane, Psy.D. Licensed Psychologist. Informed Consent to Treatment / Evaluation of a Minor Child. who was born on and who resides at Michael S. McLane, Psy.D. Licensed Psychologist 12830 Hillcrest Road Suite D233 Dallas, TX 75230 Ph: (972) 620-1225 Fax: (972) 620-4393 Informed Consent to Treatment / Evaluation of a Minor Child I am

More information

Dr. Beth Gadomski Psychologist, CA License PSY 23658

Dr. Beth Gadomski Psychologist, CA License PSY 23658 page 1 of 7 Welcome to my practice. I look forward to our work together. You may have many questions as you begin work with a psychologist who is new to you. In an effort to answer some of those questions,

More information

School Guidance and Counseling Services, Elementary, Middle, and High School

School Guidance and Counseling Services, Elementary, Middle, and High School School Guidance and Counseling Services, Elementary, Middle, and High School This regulation implements School Board Policy 651, School Guidance and Counseling Services, Elementary, Middle, and High School,

More information

Parent Talk Spring, 2006 Gifted Education Communicator (California Association for the Gifted)

Parent Talk Spring, 2006 Gifted Education Communicator (California Association for the Gifted) Parent Talk Spring, 2006 Gifted Education Communicator (California Association for the Gifted) Counseling Issues for Gifted Students: More Issues? Special Issues? Nancy M. Robinson University of Washington

More information

PATIENT / PSYCHOTHERAPIST SERVICE AGREEMENT INFORMED CONSENT. Welcome!

PATIENT / PSYCHOTHERAPIST SERVICE AGREEMENT INFORMED CONSENT. Welcome! Jeremy Frank, PhD CADC Licensed Psychologist and Certified Alcohol and Drug Counselor Presidential City Madison Building 2 Bala Plaza, Suite Plaza 13 (Pl-13) Bala Cynwyd, Pennsylvania 19004 215-356-8061

More information

Careers in Psychology

Careers in Psychology Careers in Psychology Prepared by Greta Winograd, PhD Psychology Department, SUNY New Paltz A strong background in psychology is valuable for many types of occupations, and not just in the helping professions.

More information

Office of Workforce Development & Training Behavioral Health Administration Voc Rehab Building 55 Wade Avenue, Catonsville, MD 21228

Office of Workforce Development & Training Behavioral Health Administration Voc Rehab Building 55 Wade Avenue, Catonsville, MD 21228 Office of Workforce Development & Training Behavioral Health Administration Voc Rehab Building 55 Wade Avenue, Catonsville, MD 21228 FEBRUARY 10, 11 &12 Issues & Ethics for the Helping Professional Gregory

More information

1. Emotional consequences of stroke can be significant barriers to RTW

1. Emotional consequences of stroke can be significant barriers to RTW Important Issues for Stroke Survivors to Consider When Returning to Work Rehabilitation Institute of Chicago National Institute on Disability and Rehabilitation Research 1 Stroke is a leading cause of

More information

Ferkauf Graduate School of Psychology Yeshiva University. The Max and Celia Parnes Family Psychological and Psychoeducational Services Clinic

Ferkauf Graduate School of Psychology Yeshiva University. The Max and Celia Parnes Family Psychological and Psychoeducational Services Clinic Ferkauf Graduate School of Psychology Yeshiva University The Max and Celia Parnes Family Psychological and Psychoeducational Services Clinic Welcome to the Max and Celia Parnes Family Psychological and

More information

Warner Family Counseling

Warner Family Counseling Warner Family Counseling General Policies Insurance: I will file claims on your behalf, provided that I am an in-network contracted provider with your individual plan. Prior to our first meeting contact

More information

School Counseling. PowerPoint produced by Melinda Haley, M.S., New Mexico State University.

School Counseling. PowerPoint produced by Melinda Haley, M.S., New Mexico State University. School Counseling PowerPoint produced by Melinda Haley, M.S., New Mexico State University. This multimedia product and its contents are protected under copyright law. The following are prohibited by law:

More information

Danielle C. Audet, Psy.D.

Danielle C. Audet, Psy.D. Danielle Audet, Psy.D. Page 1 of 7 Danielle C. Audet, Psy.D. Massachusetts General Hospital Law and Psychiatry Service Juvenile Court Consultation Program One Bowdoin Square, 15 New Chardon Street Boston,

More information

ST. THOMAS UNIVERSITY MS PROGRAMS IN COUNSELING MENTAL HEALTH COUNSELING FIELD EXPERIENCE POLICY MANUAL. Definition

ST. THOMAS UNIVERSITY MS PROGRAMS IN COUNSELING MENTAL HEALTH COUNSELING FIELD EXPERIENCE POLICY MANUAL. Definition ST. THOMAS UNIVERSITY MS PROGRAMS IN COUNSELING MENTAL HEALTH COUNSELING FIELD EXPERIENCE POLICY MANUAL Definition The field experience internships (CPS 790, CPS 791 and CPS 795) are required course in

More information

Kiran Mishra, Ph.D. Licensed Clinical Psychologist. Sugar Land, TX 77478 (832) 876-3232 TEXAS NOTICE FORM

Kiran Mishra, Ph.D. Licensed Clinical Psychologist. Sugar Land, TX 77478 (832) 876-3232 TEXAS NOTICE FORM Kiran Mishra, Ph.D. Licensed Clinical Psychologist 1111 Highway 6, Suite 235 Sugar Land, TX 77478 (832) 876-3232 TEXAS NOTICE FORM Notice of Psychologists Policies and Practices to Protect the Privacy

More information

Kathleen Long, Ph.D. 510 A Pollock Street New Bern, NC 28562 Phone: (252) 636-2286 Fax: (252) 636-5677

Kathleen Long, Ph.D. 510 A Pollock Street New Bern, NC 28562 Phone: (252) 636-2286 Fax: (252) 636-5677 Kathleen Long, Ph.D. 510 A Pollock Street New Bern, NC 28562 Phone: (252) 636-2286 Fax: (252) 636-5677 Welcome! Please take a minute to complete the following information. Your name: Phone Number: Address:

More information

Melanie Bierenbaum, Psy.D. Licensed Psychologist 3040 E. Cactus Rd, Suite A Phoenix, AZ 85032 Office: 602-769-2773

Melanie Bierenbaum, Psy.D. Licensed Psychologist 3040 E. Cactus Rd, Suite A Phoenix, AZ 85032 Office: 602-769-2773 Service Agreement and Treatment Consent Welcome and thank you for choosing to work with Dr. Bierenbaum. This document contains important information about professional services, the psychologist-patient

More information

oimae ;vnv ;asv ;lskaj; afesldk PSYCHOTHERAPY SERVICES AGREEMENT

oimae ;vnv ;asv ;lskaj; afesldk PSYCHOTHERAPY SERVICES AGREEMENT oimae ;vnv ;asv ;lskaj; afesldk 33493 West 14 Mile Road, Suite 130 Farmington Hills, MI 48331 (248) 851-KIDS (5437) ChildAndFamilySolutionsCenter.com afeaf eafeafew; PSYCHOTHERAPY SERVICES AGREEMENT This

More information

VACAVILLE UNIFIED SCHOOL DISTRICT Psychologist Observation/Discussion Form TEACHING STANDARD 1

VACAVILLE UNIFIED SCHOOL DISTRICT Psychologist Observation/Discussion Form TEACHING STANDARD 1 APPENDIX D SECTION M TEACHING STANDARD 1 COMMITTED TO STUDENTS AND THEIR LEARNING (check one or more of the following reflections, observations, documentation, or conferences) 1.1 Participates in formal

More information

Client Intake Information. Client Name: Home Phone: OK to leave message? Yes No. Office Phone: OK to leave message? Yes No

Client Intake Information. Client Name: Home Phone: OK to leave message? Yes No. Office Phone: OK to leave message? Yes No : Chris Groff, JD, MA, Licensed Pastor Certified Sex Addiction Therapist Candidate 550 Bailey, Suite 235 Fort Worth, Texas 76107 Client Intake Information Client Name: Street Address: City: State: ZIP:

More information

Mid Essex. Specialist Psychosis Service

Mid Essex. Specialist Psychosis Service Mid Essex Specialist Psychosis Service What is psychosis? Why have you been referred to us? Psychosis is general term used to describe a number of symptoms. Some of the symptoms of psychosis include: False

More information

Heather Carroll, PsyD, PLLC 2121 South Oneida St. Suite 240 - Denver, CO 80224 www.carrolltherapyconnections.com phone: 303-756-1355

Heather Carroll, PsyD, PLLC 2121 South Oneida St. Suite 240 - Denver, CO 80224 www.carrolltherapyconnections.com phone: 303-756-1355 Heather Carroll, PsyD, PLLC 2121 South Oneida St. Suite 240 - Denver, CO 80224 www.carrolltherapyconnections.com phone: 303-756-1355 CLIENT INFORMATION AND CONSENT Welcome to my practice. This document

More information

M.A. in School Counseling / 2015 2016

M.A. in School Counseling / 2015 2016 M.A. in School Counseling / 2015 2016 Course of Study for the Master of Arts in School Counseling Initial License (Pre K 8 or 5 12) Candidates for the degree of Master of Arts in School Counseling are

More information

Andrew Elman LPC ATR PROFESSIONAL DISCLOSURE STATEMENT

Andrew Elman LPC ATR PROFESSIONAL DISCLOSURE STATEMENT Personal counseling is conducted in various ways, depending on the counselor. As my client, you have the right to know my qualifications, methods, and mutual expectations of our professional relationship.

More information

Dr. Keith Hudson s Vita

Dr. Keith Hudson s Vita Dr. Keith Hudson s Vita Jackson State University Department of Psychology 601 979 3383 EDUCATION Mississippi State University Ph.D. in Counselor Education & Educational Psychology (Counseling) M.S. in

More information

AGREEMENT FOR THE PROVISION OF FORENSIC PSYCHOLOGICAL SERVICES: OFFICE POLICIES AND PROCEDURES

AGREEMENT FOR THE PROVISION OF FORENSIC PSYCHOLOGICAL SERVICES: OFFICE POLICIES AND PROCEDURES BRUCE ARTHUR OLSON, PH.D. CLINICAL AND FORENSIC PSYCHOLOGY MEDICAL-DENTAL BUILDING OF RICHMOND HIGHLANDS 18532 FIRLANDS WAY NORTH, SUITE A SEATTLE, WASHINGTON 98133 TELEPHONE (206) 542-7516 FACSIMILE (206)

More information

Clinical Mental Health Counseling

Clinical Mental Health Counseling Clinical Mental Health Counseling University of North Georgia Clinical Handbook INTRODUCTION The purpose of the Clinical Mental Health Counseling Practicum & Internship Handbook is to provide you with

More information

Ellyn L. Turer, PsyD, PLLC 1320 19 th Street, NW Suite 202 Washington, DC 20036 Tel: 202-293-6463, ellyn-turer@hushmail.com

Ellyn L. Turer, PsyD, PLLC 1320 19 th Street, NW Suite 202 Washington, DC 20036 Tel: 202-293-6463, ellyn-turer@hushmail.com Date CLIENT INFORMATION Client Name Address City State Zip Code Primary Contact Ph # Cell Home Work Secondary Ph # Cell Home Work Email Address Do you text? Yes No Birth date Social Security Number Occupation

More information

Colorado Springs Office 3210 E. Woodmen Rd., #100 Colorado Springs, CO, 80920. Denver Office 837 Sherman St. Denver, CO 80203

Colorado Springs Office 3210 E. Woodmen Rd., #100 Colorado Springs, CO, 80920. Denver Office 837 Sherman St. Denver, CO 80203 Colorado Springs Office 3210 E. Woodmen Rd., #100 Colorado Springs, CO, 80920 Denver Office 837 Sherman St. Denver, CO 80203 Welcome to my practice. I am honored that you are giving me the opportunity

More information

Welcome. ISBE Non Public School Conference 2012 KSteffan

Welcome. ISBE Non Public School Conference 2012 KSteffan Welcome 1 What Schools Need to Know About Vocational Rehabilitation A Nationwide System of Vocational Support for People with Disabilities Karen Steffan, LADSE Today s Objectives Provide you with an understanding

More information

Client Initial Interview Form. Address: City: State: Zip: Phone: (h) (C) May I leave messages at these phone numbers? yes no

Client Initial Interview Form. Address: City: State: Zip: Phone: (h) (C) May I leave messages at these phone numbers? yes no Nancy Thomas, M.A., LPC-Intern Supervised by Jennifer Perla, LPC-S The Vale Counseling and Therapeutic Center 2862 N. Belt Line Road, Sunnyvale, TX 75182 www.nancythomascounseling.com Office: (972) 698-8478

More information

Employee EAP and Work-Life Orientation. University System of New Hampshire

Employee EAP and Work-Life Orientation. University System of New Hampshire Employee EAP and Work-Life Orientation University System of New Hampshire What is an EAP? An employee benefit which provides confidential counseling and/or consultation for a variety of issues that may

More information

Counseling Intake Form (Each person attending therapy should complete a form)

Counseling Intake Form (Each person attending therapy should complete a form) Counseling Intake Form (Each person attending therapy should complete a form) Name Male Female Mailing Address Date of Birth Home Phone Work Email How would you like to be contacted? Home Work Email Okay

More information

Mendel Psychological Associates

Mendel Psychological Associates PSYCHOLOGIST- PATIENT SERVICES AGREEMENT This document is an agreement between therapist: and client:. Welcome to our practice. This document (the Agreement) contains important information about professional

More information

Play Therapy, Individual, and Group Counseling Keshia Lori Smith, M.S., LPC (469)323-6248 keshia.l.smith@gmail.com

Play Therapy, Individual, and Group Counseling Keshia Lori Smith, M.S., LPC (469)323-6248 keshia.l.smith@gmail.com Play Therapy, Individual, and Group Counseling Keshia Lori Smith, M.S., LPC (469)323-6248 keshia.l.smith@gmail.com PROFESSIONAL DISCLOSURE STATEMENT Qualifications: I am a qualified Licensed Professional

More information

Bradley D. Powell, PhD NOTICE OF PRIVACY PRACTICES: Effective June 1, 2004

Bradley D. Powell, PhD NOTICE OF PRIVACY PRACTICES: Effective June 1, 2004 Bradley D. Powell, PhD NOTICE OF PRIVACY PRACTICES: Effective June 1, 2004 A Summary of the Provisions of the Health Insurance Portability and Accountability Act ( HIPAA ) Privacy Rule (45 C.F.R. parts

More information

Preparing for Grad School

Preparing for Grad School Department of Psychology Preparing for Grad School University of California, Davis 2012 Advising: 141 Young Hall Which degree? Which grad school? Adapted from a piece by Associate Dean for Student Affairs,

More information

Jin Nothmann, Psy.D. 66 Painter s Mill Road Suite 204 Owings Mills, MD 21117 (443) 394-0768, ext. 5

Jin Nothmann, Psy.D. 66 Painter s Mill Road Suite 204 Owings Mills, MD 21117 (443) 394-0768, ext. 5 1 Jin Nothmann, Psy.D. 66 Painter s Mill Road Suite 204 Owings Mills, MD 21117 (443) 394-0768, ext. 5 Licensure: State of Maryland Psychologist License #3762 Education 12/95-5/15/99 Psy.D. Clinical Psychology

More information

TIVERTON PSYCHOLOGICAL SERVICES 2128 MAIN ROAD TIVERTON, RI 02878 www.tivertonpsych.com Phone: 401-624-9972; Fax: 401-624-1452

TIVERTON PSYCHOLOGICAL SERVICES 2128 MAIN ROAD TIVERTON, RI 02878 www.tivertonpsych.com Phone: 401-624-9972; Fax: 401-624-1452 TIVERTON PSYCHOLOGICAL SERVICES 2128 MAIN ROAD TIVERTON, RI 02878 www.tivertonpsych.com Phone: 401-624-9972; Fax: 401-624-1452 Dorothy B. Brown, Ph.D. Anne Davidge, Ph.D. Dennis J. Rog, Ed.D. Licensed

More information

Clinical Mental Health Counseling

Clinical Mental Health Counseling Clinical Mental Health Counseling University of North Georgia Practicum & Internship Handbook If you need this document in another format, please call Shanta Ghimire at 706-867-2791 or email shanta.ghimire@ung.edu.

More information

1. Comparison of CACREP Standards with licensure standards of Maryland, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont.

1. Comparison of CACREP Standards with licensure standards of Maryland, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont. 1. Comparison of CACREP Standards with licensure standards of Maryland, Massachusetts, Maine, New Hampshire, New York, Rhode Island, and Vermont. MA Credits need for Licensure Degrees Allowed Educational

More information

LG/LCADC (Licensed Graduate or Licensed Clinical Alcohol and Drug Counselor) Pre-Application Credentials Evaluation Instructions

LG/LCADC (Licensed Graduate or Licensed Clinical Alcohol and Drug Counselor) Pre-Application Credentials Evaluation Instructions Maryland Board of Professional Counselors and Therapists 4201 Patterson Avenue Baltimore, MD 21215 410-764-4732 or 410-764-4740 www.dhmh.maryland/bopc/ LG/LCADC (Licensed Graduate or Licensed Clinical

More information

Lisa C. Tang, Ph.D. Licensed Clinical Psychologist 91 W Neal St. Pleasanton, CA 94566 (925) 963-8835

Lisa C. Tang, Ph.D. Licensed Clinical Psychologist 91 W Neal St. Pleasanton, CA 94566 (925) 963-8835 Lisa C. Tang, Ph.D. Licensed Clinical Psychologist 91 W Neal St. Pleasanton, CA 94566 (925) 963-8835 Professional Policies and Consent to Treatment Welcome to my practice. I appreciate your giving me the

More information

Psychotherapy Treatment of Bipolar Disorders

Psychotherapy Treatment of Bipolar Disorders Psychotherapy Treatment of Bipolar Disorders Jenifer L. Culver, Ph.D. Clinical Assistant Professor Bipolar Disorders Clinic Stanford University School of Medicine Overview Overview of research-based psychotherapies

More information

Declaration of Practices and Procedures

Declaration of Practices and Procedures Peggy S. Arcement, MS, MA, LDN, LPC, NCC Licensed Professional Counselor Baton Rouge Christian Counseling Center 763 North Boulevard, Baton Rouge, Louisiana 70802 Phone: 225-387-2287 Fax: 225-383-2722

More information

COMMUNITY COLLEGE OF BALTIMORE COUNTY, DEPARTMENT OF TEACHER EDUCATION. Welcome to the Teacher Education Program

COMMUNITY COLLEGE OF BALTIMORE COUNTY, DEPARTMENT OF TEACHER EDUCATION. Welcome to the Teacher Education Program COMMUNITY COLLEGE OF BALTIMORE COUNTY, DEPARTMENT OF TEACHER EDUCATION Welcome to the Teacher Education Program WHY CHOOSE CCBC? CCBC s Early Childhood program allows you to: Earn credits towards your

More information

Dear. Your initial appointment has been scheduled for:

Dear. Your initial appointment has been scheduled for: Jessica Brown, Psy. D. Licensed Psychologist Parkdale Therapy Group Parkdale Plaza 1660 South Highway 100 #330 St. Louis Park, MN 55416 952-224-0399 Ext. 4 Dear Your initial appointment has been scheduled

More information

Agreement for Therapy and Informed Consent

Agreement for Therapy and Informed Consent Agreement for Therapy and Informed Consent Welcome to the counseling program of St. Joseph Family Center. This Agreement for Therapy contains important information about our professional services and business

More information

The Field of Counseling

The Field of Counseling Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration

More information

Missouri Valley College Counseling Center Policy and Procedures

Missouri Valley College Counseling Center Policy and Procedures Missouri Valley College Counseling Center Policy and Procedures 500 E College St. Marshall, MO 65340 660-831-4139 660-831-4071 Adopted: August 2012 MVC Counseling Center Policy and Procedure Manual Page

More information

ADULT REGISTRATION FORM. Last Name First Name Middle Initial. Date of Birth Age Identified Gender. Street Address. City State Zip Code

ADULT REGISTRATION FORM. Last Name First Name Middle Initial. Date of Birth Age Identified Gender. Street Address. City State Zip Code ADULT REGISTRATION FORM Last Name First Name Middle Initial Date of Birth Age Identified Gender Street Address City State Zip Code Home Phone Cell Phone FINANCIALLY RESPONSIBLE PARTY (If different from

More information

PSYCHOLOGICAL SERVICES AT UWSP & THE CHANGING PICTURE OF UNDERGRADUATE MENTAL HEALTH

PSYCHOLOGICAL SERVICES AT UWSP & THE CHANGING PICTURE OF UNDERGRADUATE MENTAL HEALTH PSYCHOLOGICAL SERVICES AT UWSP & THE CHANGING PICTURE OF UNDERGRADUATE MENTAL HEALTH Dr. Jason J. Siewert, Licensed Psychologist. UWSP Counseling Center Goals for today. Introduce and clarify the nature

More information

How To Become A Mental Health Counselor

How To Become A Mental Health Counselor Becoming a Mental Health Counselor 12pm to 1pm (PST) Becoming a Mental Health Counselor Have you ever considered becoming a professional counselor? Do you have an interest in getting into the field of

More information

Relational Connections

Relational Connections INFORMED CONSENT Relational consists of individual, couples, and therapy services provided in Minneapolis with the objective to promote growth in individuals, couples and families. These services are provided

More information

Meet Our Counseling Staff

Meet Our Counseling Staff Meet Our Counseling Staff Kari Wittmann Lata, Clinical Director, earned her MS from Northern Illinois University in Marriage and Family Therapy. She has worked in private practice, inpatient facilities,

More information

UNIVERSITY COUNSELING SERVICES SOUTHERN CONNECTICUT STATE UNIVERSITY EN 219-B NEW HAVEN, CT 06515

UNIVERSITY COUNSELING SERVICES SOUTHERN CONNECTICUT STATE UNIVERSITY EN 219-B NEW HAVEN, CT 06515 UNIVERSITY COUNSELING SERVICES SOUTHERN CONNECTICUT STATE UNIVERSITY EN 219-B NEW HAVEN, CT 06515 Dear Applicant: Thank you for your interest in our graduate internship program. The University Counseling

More information

SENIOR MENTAL HEALTH COUNSELOR I/II

SENIOR MENTAL HEALTH COUNSELOR I/II SENIOR MENTAL HEALTH COUNSELOR I/II DEFINITION To perform a variety of complex professional duties in the provision of outpatient and crisis mental health services to individuals and groups. DISTINGUISHING

More information

Betsy Mencher, Ph.D. Licensed Clinical Psychologist 1350 Connecticut Avenue, NW Suite 602 Washington, DC 20036

Betsy Mencher, Ph.D. Licensed Clinical Psychologist 1350 Connecticut Avenue, NW Suite 602 Washington, DC 20036 Betsy Mencher, Ph.D. Licensed Clinical Psychologist 1350 Connecticut Avenue, NW Suite 602 Washington, DC 20036 PSYCHOLOGIST-CLIENT SERVICES AGREEMENT Welcome to my practice. This document (the Agreement)

More information

Jennifer L. Trotter, Ph.D.

Jennifer L. Trotter, Ph.D. Jennifer L. Trotter, Ph.D. Telephone: 248-880-4966 - Email: JenniferLTrotter@gmail.com Licensed Clinical Psychologist Address: 25882 Orchard Lake Road - Suite L-4 - Farmington Hills, MI 48336 OUTPATIENT

More information

Careers in Psychology

Careers in Psychology Careers in Psychology Presented by Career Services The University of Toledo Occupations today require a college educated individual who can Write and speak well Solve problems Learn new information quickly

More information

JUDITH A. McCONNELL, PH.D. Director: Counseling and Testing Services, University of North

JUDITH A. McCONNELL, PH.D. Director: Counseling and Testing Services, University of North JUDITH A. McCONNELL, PH.D. Counseling and Testing Services University of North Texas P.O. Box 310968 Denton, Texas 76203-0968 (940) 565-2741 judym@dsa.adminunt.edu EDUCATION Ph.D. M.Ed. B.A. December 1978

More information

CHILDREN S MENTAL HEALTH SERVICES CLIENT WELCOME AND ORIENTATION INFORMATION

CHILDREN S MENTAL HEALTH SERVICES CLIENT WELCOME AND ORIENTATION INFORMATION CHILDREN S MENTAL HEALTH SERVICES Serving Children, Youth and Families in Hastings and Prince Edward Counties CLIENT WELCOME AND ORIENTATION INFORMATION Working Towards a Brighter Future! An Accredited

More information

The counseling program for high school students may include, at appropriate grade levels:

The counseling program for high school students may include, at appropriate grade levels: BP 6164.2(a) Instruction GUIDANCE/COUNSELING SERVICES The Governing Board recognizes that a comprehensive counseling program promotes academic achievement and serves the diverse needs of all district students.

More information

FISCAL IMPACT: This is an information item only; there is no fiscal impact associated with this item.

FISCAL IMPACT: This is an information item only; there is no fiscal impact associated with this item. BOARD OF REGENTS SUMMARY OF ITEM FOR ACTION, INFORMATION OR DISCUSSION TOPIC: Report on Campus Mental Health Services COMMITTEE: Education Policy and Student Life DATE OF COMMITTEE MEETING: November 20,

More information

Guidance and Counseling

Guidance and Counseling Guidance and Counseling Judson ISD Professional school counselors: Hold a Master s degree in counseling Have a minimum of two years of teaching experience Are certified in School Counseling through the

More information

Opening DORS to Employment Division of Rehabilitation Services www.dors.maryland.gov

Opening DORS to Employment Division of Rehabilitation Services www.dors.maryland.gov Opening DORS to Employment Division of Rehabilitation Services www.dors.maryland.gov The Public Rehabilitation Program: The Maryland Division of Rehabilitation Services (DORS) is a state agency with programs

More information

SUE W. LUCAS. Telephone: (325) 670-1538 Telephone: (325) 692-4518

SUE W. LUCAS. Telephone: (325) 670-1538 Telephone: (325) 692-4518 SUE W. LUCAS Office: Home: Hardin-Simmons University 2201 Woodard St. Department of Psychology Abilene, Texas 79605 HSU Box 16115 Abilene, Texas 79698 Telephone: (325) 670-1538 Telephone: (325) 692-4518

More information

KING COUNTY COLLABORATIVE LAW PROTOCOLS FOR DIVORCE COACHES

KING COUNTY COLLABORATIVE LAW PROTOCOLS FOR DIVORCE COACHES KING COUNTY COLLABORATIVE LAW PROTOCOLS FOR DIVORCE COACHES These protocols are intended to set forth general best practices for coach members of King County Collaborative Law, not adapted to particular

More information

1 REVISOR 8710.6400. (2) basic diagnostic classifications and referral mechanisms of the helping

1 REVISOR 8710.6400. (2) basic diagnostic classifications and referral mechanisms of the helping 1 REVISOR 8710.6400 8710.6400 SCHOOL COUNSELOR. Subpart 1. Scope of practice. A school counselor is authorized to provide to kindergarten through grade 12 students school counseling services that focus

More information

LEIGH WEISZ, PSY.D. LICENSED CLINICAL PSYCHOLOGIST 900 SKOKIE BLVD SUITE 115 NORTHBROOK, IL 60062

LEIGH WEISZ, PSY.D. LICENSED CLINICAL PSYCHOLOGIST 900 SKOKIE BLVD SUITE 115 NORTHBROOK, IL 60062 PHONE: 847.497.8378 LEIGH WEISZ, PSY.D. LICENSED CLINICAL PSYCHOLOGIST 900 SKOKIE BLVD SUITE 115 NORTHBROOK, IL 60062 Intake Form Date of Intake: Caller: DRLEIGHWEISZ.COM Referral Source: May I thank referral

More information

SCHOOL MENTAL HEALTH RESPONSE GUIDELINES

SCHOOL MENTAL HEALTH RESPONSE GUIDELINES 1 SCHOOL MENTAL HEALTH RESPONSE GUIDELINES The School Mental Health Response Staff may consist of a variety of members of the school s SBSLT (School Based Support Learning Team), including but not limited

More information

Rehabilitation & Mental Health Counseling Program Manual 1

Rehabilitation & Mental Health Counseling Program Manual 1 Rehabilitation & Mental Health Counseling Program Manual 1 I. INTRODUCTION ILLINOIS INSTITUTE OF TECHNOLOGY DIVISION OF COUNSELING AND REHABILITATION SCIENCE MASTER OF SCIENCE IN REHABILITATION AND MENTAL

More information

Clinical/Counselling Psychology Service

Clinical/Counselling Psychology Service Clinical/Counselling Psychology Service Exceptional healthcare, personally delivered What are Clinical/Counselling Psychologists? Clinical/Counselling Psychologists begin their training by studying normal

More information

PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT

PSYCHOTHERAPIST-PATIENT SERVICES AGREEMENT The Bethesda Group Psychological Services, LLC Old Georgetown Office Park 7988 Old Georgetown Road, 8A Bethesda, Maryland 20814 Phone 301.718.4544 Fax 301.718.4545 info@thebethesdagroup.com PSYCHOTHERAPIST-PATIENT

More information

VITA. Brian A. Chopko 2737 Owaisa Road Cuyahoga Falls, OH 44221 330 920-1197 bchopko@kent.edu EDUCATION

VITA. Brian A. Chopko 2737 Owaisa Road Cuyahoga Falls, OH 44221 330 920-1197 bchopko@kent.edu EDUCATION VITA Brian A. Chopko 2737 Owaisa Road Cuyahoga Falls, OH 44221 330 920-1197 bchopko@kent.edu Ph.D. Counselor Education and Supervision The University of Akron, 12/07 M.A. Rehabilitation Counseling Kent

More information

Resources Promoting Wellness and Resiliency in Schools

Resources Promoting Wellness and Resiliency in Schools Resources Promoting Wellness and Resiliency in Schools Kristina Crawford, NCSP, School Psychologist Chantilly High School E.J. Stapler, LPC, NCC, DCC, School Counselor Chantilly High School 30% of

More information

Master of Arts Programs in the Faculty of Social and Behavioral Sciences

Master of Arts Programs in the Faculty of Social and Behavioral Sciences Master of Arts Programs in the Faculty of Social and Behavioral Sciences Admission Requirements to the Education and Psychology Graduate Program The applicant must satisfy the standards for admission into

More information

How To Become A Clinical Psychologist

How To Become A Clinical Psychologist How do I become a counsellor? Students taking psychology are often interested in becoming counsellors or therapists. This guide is intended to assist with students who wish to go down this path. Please

More information