General Information:
You are receiving therapeutic services from a therapist who is currently enrolled in a Master level counseling training program with a US based university. Our goal, in coordinating with these programs, is to provide guidance and support through supervision of all trainees as they offer consistent and professionally competent services for their clients. To accomplish this goal, we routinely use video and audio recording and direct supervision of sessions. Video/audio recording, supervision, and consultation are standard practices in counseling training and education throughout the profession and are used to assist the therapist in improving skills and in planning for future sessions. Just as importantly, these tools help us, the therapists’ clinical supervisors, ensure that you are receiving the best possible care.

Video and audio recordings are treated in a way to ensure that they remain confidential. They are not shared in any way not specifically addressed in this Informed Consent. We hope that this information helps you understand our method of operation and the reasons behind it. Do not hesitate to ask questions or discuss any part of our procedures with your therapist. You may also contact the Clinical Supervisor assigned to your therapist by contacting the office at 575-556-9585 or via email at info@anewhopetc.org, if you have additional questions.

Confidentiality:
Information gathered in the sessions will be held with the same confidentiality laws of all clients at A New Hope Therapy Center. Session details will be discussed with your therapist’s supervisor for the purpose of feedback and support. Your case records, including video/audio recordings, will be kept confidential and private unless disclosure is authorized or required by law. Within the limits of this confidentiality agreement, your therapist may discuss and review your case information with their supervisor and with a supervising faculty member and supervision group within their training program. All supervisors and participants in the supervision group have committed to uphold the professional standard of confidentiality. Additionally, every possible effort is taken by your therapist to limit the disclosure of any identifying information. All supervisors and therapists who are granted access to this confidential material are bound by the same ethical standards of confidentiality as your primary therapist. A New Hope Therapy Center’s primary informed consent will provide you with additional information about limits to confidentiality as set forth by NM state laws.

Code of Conduct:
If for any reason you have questions about counseling or are dissatisfied, you have the right to meet with your therapist and/or the Clinical Director, Jessica Cauthorne, LCSW.

Fees and Office Procedures:
As a courtesy we will bill your insurance for your services, however you are responsible for all copays, deductibles and other fees at the time of services. The fee for services with our clinical interns without insurance is $35 per session, paid to A New Hope Therapy Center.

Emergency Situations:
You may leave a message at your assigned therapist’s personal number and your call will be returned within 24 business hours. In an emergency situation when an immediate response is necessary, please call 911 or go to the nearest emergency room for attention.

I have read the above and understand the nature of the consent form for services with a clinical intern.