Discover Hope

Informed Consent and Confidentiality Agreement - Individual Coaching


Confidentiality Agreement: Discover Hope Behavioral Solutions, Inc.’s (“Discover Hope”) members, as more fully described in Radiant Parent Membership Program Terms and Conditions, will have the right to confidentiality by the counseling staff, interns, volunteer leaders, and other employees (collectively referred to as “Staff”) of Discover Hope. While Discover Hope urges members to respect any and all confidential information shared by other group members, Discover Hope shall not be held responsible for any dissemination of confidential information by other group members.

Informed Consent: Discover Hope follows the legal, ethical, and professional standards related to confidentiality. In the following situations, however, Discover Hope facilitators are legally obligated to contact the authorities:

  • If a group member becomes a danger to himself/herself or another person
  • If knowledge is attained regarding abuse/neglect of a minor
  • Responding to a legal issue such as a court subpoena or other legal matter

As a member of Discover Hope, I agree not to share personal information (including names, telephone number, and/or home address) of any group member and/or disclose confidential details of any discussions had during group activities, including but not limited to, book clubs, behavior consultation sessions, online workshops, parent groups, and social meetups, facilitated by Discover Hope. This duty of confidentiality shall remain even after the completion of such activities and after the termination of membership. Additionally, members agree to respect the Staff and to cooperate with other members during group activities facilitated by Discover Hope.

By signing below, member agrees to have read and understood the Discover Hope Member Informed Consent and Confidentiality Agreement.

Date:

Leave this empty:

Signature Certificate
Document name: Informed Consent and Confidentiality Agreement - Individual Coaching
Unique Document ID: 854a8889e610d1e6ad584a5447180d62ee0faef9
Timestamp Audit
September 24, 2019 8:15 pm PSTInformed Consent and Confidentiality Agreement - Individual Coaching Uploaded by Melissa Schulz - info@discover-hope.com IP 68.3.29.160