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Willie J. Wallace, SAP, CEAP, LMSW provides evaluations, short-term counseling, education, and case management to individuals and their immediate family members. Because this counseling is a brief intervention, it is appropriate for helping someone deal with newly emerging issues that need evaluation, crisis situations, and minor to moderate level issues that lend themselves to a problem solving approach. This counseling is not adequate to treat long term mental health issues, extensive marital or family therapy problems, or chemical addiction. For serious concerns such as these, we will make an assessment, provide short-term support, and refer you to other appropriate health care professionals or treatment centers who can assist you for the longer duration of treatment these issues require.

I understand that I am entering counseling freely and that I will participate in open, honest communication with my counselor about information that has a bearing on my progress and safety in counseling. I understand that I may withdraw from counseling at any time and that my counselor will provide me with names of other qualified professionals or treatment centers. I hereby release Northshore Recovery Associates from any responsibility for injury or harm which results from my terminating counseling against clinical advice.

While most people benefit from counseling, I understand there are risks associated with my engaging in counseling. I understand that I may learn things about myself or my relationships that I didn't realize before, that I don't like, or that may cause me sadness, anxiety, and other emotional discomfort. I understand that as I work through issues to make desired changes in my life, I will be taking part in a collaborative process. My Counselor will support me using appropriate and approved counseling techniques that will respect my values, beliefs, faith and right to self-determination.

I understand my counselor follows Federal and State Laws and Professional Ethical Standards prohibiting the disclosure of any information I provide us unless I have given prior written consent. I am aware there are exceptions to maintaining confidentiality in certain situations, some of which are listed below.

–If my counselor believes that I or someone else is in clear and imminent danger of harm, then my Counselor is legally obligated to inform proper authorities and others to help prevent harm from occurring.

–If I provide information that a minor, an elder, or a person who is disabled is being abused, my Counselor must notify proper authorities.

–If I am a minor and not emancipated, married or a parent, my parents may have access to my records.

–In rare cases, a court may order my Counselor to disclose information about me.

I understand that should I have an emergency, I will leave a message for my counselor. Should my counselor not be able to return my call immediately, I understand that I can call The Phone Crisis Hotline at (225) 924-3900 or go to the nearest emergency room.

I understand that afternoon appointments are the times most in demand. I will plan ahead if I need a prime time appointment, as availability is limited. I am aware there is no childcare available for children not attending counseling and I will make arrangements elsewhere for their supervision. If I am unable to keep an appointment, I will call and cancel in a timely fashion. I understand that occasionally an emergency may pre-empt my visit and that my Counselor will make every effort to reschedule the session as soon as possible.

I hereby consent to receive behavioral health counseling as provided by Willie J. Wallace, SAP, CEAP, LMSW and authorize the administration of assessments and treatments considered advisable in the diagnosis and treatment of my condition.