Counselor-Client Agreement + Consent

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THIS AGREEMENT + INFORMED CONSENT executed on this, the day of submission, is agreed to be effective upon approval of eCounseling.com, by eCounseling.com and Applicant (hereinafter “Counselor”). This agreement, containing relevant practice management information, also functions as a preliminary informed consent document for eCounseling clients.

SECTION 1—SERVICES

1.1 Term. Upon review, eCounseling.com agrees to allow Counselor to use eCounseling.com technology to perform independent counseling services, as stated in section 1.2 of this agreement.

1.2 Duties (Legal). Counselor agrees to competently perform only professional work that is lawful and within the bounds of Counselor’s license.

1.3 Duties (Fee Collection). For online and phone clients, Counselor agrees to collect fees through the eCounseling.com payment terminal, and not accept payment from the client or by any other method.

1.4 Duties (Work Quantity).There is no minimum or maximum amount of counseling that is required to be conducted by Counselor, except for the responsibility to maintain scheduled appointments. There is no responsibility by eCounseling.com to provide any specific quantity of prospective counseling clients to Counselor. eCounseling.com provides technology for online and phone counseling to take place, and a search engine for the listing of counselors’ local practices. eCounseling.com strives to nationally promote eCounseling.com Counselors, though effectiveness of marketing attempts is not guaranteed.

1.5 Completion Date. This agreed relationship is to be maintained on an ongoing basis unless eCounseling.com or Counselor deems a termination of contract appropriate. eCounseling.com reserves the right to remove counselor from professional listing for any reason, without penalty. Common reasons for removal include but are not limited to Counselor license suspension or loss, lack of good standing with Counselor’s licensing boards, Counselor’s lack of proper liability insurance (1 million occurrence/3 million aggregate), poor client feedback, missed sessions, or suspected unethical and unlawful behavior.

SECTION 2 –PAYMENTS & COMPENSATION

2.1 Client Payment and Technology Fees. In consideration of all services to be rendered by phone or online, Counselor may set his/her own counseling rates, to be paid by counseling clients prior to counseling. Counselor agrees to have all payments by phone and online clients processed through the eCounseling.com payment terminal, and to pay all eCounseling.com technology fees—which are withheld from the counselors posted fee. Technology fees are currently $15 per session for online chat and phone counseling, and $10 per session for email exchange. eCounseling.com reserves the right to lower or raise technology and administrative fees, for which a one month notice will be given to all Counselors.

2.2 Counselor Compensation. Counselors will be reimbursed promptly on the following basis: Client payment of services is automatically deposited into a Paypal.com account. If the counselor does not have a Paypal.com account, an email will automatically be sent to the counselor by paypal.com, informing the counselor that money has been paid to them. The counselor will need to sign up for a free Paypal.com account to receive their client’s payment.

2.3 Chargebacks. When a client requests a chargeback on their card for services rendered, eCounseling.com may request assistance from counselors in the form of a record of sessions, or other assistance to contest the chargeback. In the instance of an approved chargeback, the contested sum will be charged to the counselor.

2.4 Withholding. Counselor shall be responsible for his/her own income taxes and other employment taxes.

2.5 Counselor Application. Counselor pays a one time application fee (amount posted on eCounseling.com). This fee is non-refundable and does not guarantee application approval.

2.6 Counselor Subscription. Counselor pays a yearly charge to be verified by eCounseling.com (amount posted on eCounseling.com), and have access to eCounseling.com distance counseling technologies and support. This fee is charged immediately after Counselor’s application review and approval. This fee is agreed upon for the period of one year. Despite payment, counselor must maintain criteria listed in section 1.5 to continue use of eCounseling.com services.

SECTION 3 – INDEPENDENT CONTRACTOR STATUS

3.1 Counselor acknowledges that s/he is an independent contractor and is not an agent, partner, joint venturor or employee or any other kind or representative of eCounseling.com. Counselor shall have no authority to contract, bind or otherwise obligate eCounseling.com in any manner.

SECTION 4 – REPRESENTATIONS OF WARRANTIES OF COUNSELOR

4.1 Counselor represents and warrants to eCounseling.com regarding the work to be performed as follows: Services are provided competently, ethically, and within the bounds of Counselor’s counseling license and professional experience—and in accordance to the terms of this agreement. Counselors shall not knowingly provide counseling to legal minors or dependent adults with the use of eCounseling.com technologies. eCounseling shall not be responsible for any counseling given to any minor or non-competent adult client.

4.2 Counselor agrees to maintain valid mental health licensure and ordination in good standing, and professional liability insurance (minimum 1 million occurence/3 million aggregate).

SECTION 5 – INFORMED CONSENT DATA

5.1 ABOUT YOUR COUNSELOR. All counselors who provide eCounseling services on eCounseling.com possess advanced degrees (masters or doctorate) in the fields of counseling, psychology, pastoral counseling, marriage and family therapy, psychiatry, psychiatric nursing, or clinical social work. In addition, all counselors providing eCounseling services (“verified” counselors) have undergone a credential check to confirm they are in good standing with their licensure/ordination boards, and that they have sufficient professional liability insurance (1-million incident, 3-million aggregate minimum, at least). Clients are encouraged to confirm this information for themselves, for changes in counselor status could occur between the time that eCounseling.com performs a credential check, and the time a client solicits counseling services. If you desire to confirm a counselor’s credentials, you may use information from the counselor profile on eCounseling.com, or please discuss the issue with your counselor.

5.2 PHILOSOPHY OF PRACTICE. Philosophies of practice or theories of counseling used vary between counselors. The counselors on eCounseling.com have been trained in a variety of counseling theories, and the counseling techniques any specific counselor uses will be unique to that particular counselor. Clients are encouraged to read their counselor’s greeting, which can be found on the counselor profile page, which should provide information on the counselor’s philosophy of practice. Clients are also encouraged to discuss with their counselors the counselor’s philosophy of counseling during an initial counseling session.

5.3 ADVANTAGES AND LIMITATIONS OF ECOUNSELING SERVICES. eCounseling may possess both advantages and limitations that will directly affect you, the client. Some of the advantages of eCounseling include convenience, affordability, flexibility, a sense of safety, anonymity, and decreased social stigma. The limitations include, but are by no means limited to, the lack of non-verbal communications, pragmatic challenges of building rapport over a distance, and the potential for eCounseling to be less effective treatment than in-person services. There is an increasing foundation of research regarding eCounseling practice, and concerned clients are encouraged to look into this research before agreeing to eCounseling services. On eCounseling.com there are several articles posted, one by Anthony Centore Ph.D. titled “The eCounseling Controversy: Proposed Advantages and Disadvantages of Telephone and Internet Therapy”.

5.4 FEES AND INSURANCE POLICY. Fees per session are set by each counselor, and vary between counselors. Full payment shall be made, by the client, before the beginning of each session. Clients agree to pay the full counselors fee even if they intend to use insurance for reimbursement. At this time eCounseling.com is unable to bill insurance on behalf of a client. However, we will provide clients with all the necessary information so that clients may submit their own personal claim. Clients understand they are fully responsible for all fees if insurance or other vendor does not pay. Refunds can be granted to clients only in the instance of a counselor being unavailable at the time of a session (services not rendered). Fees cannot be refunded in the instance of a client missing a session, a client deciding not to participate in eCounseling, or a client’s perception that a counselor’s services were unhelpful.

5.5 CANCELLATION POLICY. All scheduled sessions between a client and counselor are final and cannot be cancelled or modified. In the event of a no-show, a counselor may attempt to contact the client once (within a week of the session) to determine if the client wishes to schedule another appointment, or whether counseling has been terminated. If you do not wish your counselors to contact you, please make the counselor aware of this and your privacy will be respected. If a client is late for a session, the session will continue as planned, however the session cannot be extended to make up for the late start. For example, is a session is scheduled from 3:00-3:50, and a client “arrives” at a quarter past the hour, the session must still end at the designated time of 3:50. If a counselor is tardy, sessions may be extended to make up for the tardiness. If an extended session is not desirable by the client, the session can be rescheduled, fees can be pro-rated, or the client can request the time be added to another session on another day. We believe this is an honest and fair approach to dealing with the issue of counselor and client attendance.

5.6 CONFIDENTIALITY POLICY. All therapeutic communications, records, and contacts with professional and support staff will be held in strict confidence. Information may be released, in accordance with state law, only when (1) the client signs a written release of information indicating informed consent to such release; (2) the client expresses serious intent to harm himself/herself or someone else, clearly identified; (3) there is evidence or reasonable suspicion of abuse against a minor child, elder person (sixty-five years or older), or dependent adult; or (4) a subpoena or other court order is received directing the disclosure of information. It is our policy to assert either (a) privileged communication in the event of #4 or (b) the right to consult with clients, if at all possible barring an emergency, before mandated disclosure in the event of #2 or #3. Although we cannot guarantee it, we will endeavor to apprise the client of all mandated disclosure. Clients with any concerns or questions about this policy and their limits of confidentiality agree to raise them with their counselor at the earliest possible time to resolve them in the client’s best interest. Confidentiality has been an important issue in eCounseling provision. Clients are to be aware that there is a possibility that confidential information could be intercepted during transit (over phone lines, or through the Internet). However, some experts maintain that confidentiality in distance counseling—especially online—occupies greater security than face-to-face counseling. It has been suggested that face-to-face counseling communications are often compromised by “casual security breaches” such as persons listening by the door (Derrig-Palumbo & Zeine, 2005, p. 42). Often clients are seen by others in the waiting room of a clinic, or entering a counselor’s office, both which makes confidentiality invalid. In contrast, distance counseling occupies less of an opportunity for “casual” security breaches. Lastly, eCounseling.com has implemented industry standard securities to keep communications as safe and confidential as possible (and HIPAA compliant)—using a secure server and secure socket layer technology. If you have any addition questions regarding the confidentiality and security of eCounseling, please contact us at support@eCounseling.com and we will be attempt to answer any questions regarding this issue.

5.7 WORK AGREEMENT. It is agreed that the client shall make a good-faith effort at personal growth and engage in the counseling process as an important priority at this time in his or her life. Client gain is most important in professional counseling. Suspension, termination, or referral shall be discussed between counselor and client if a pattern of behavior shows disinterest or lack of commitment, or if any unresolved conflict or impasse between counselor and client occurs. eCounselors assess the suitability of potential clients for eCounseling care. eCounseling may be insufficient to provide ongoing service to clients with severe pathology, or who are in crisis or life threatening situations. If an eCounselor anticipates that a potential client will or might require in-person care at some point, the counselor shall inform the client of this prediction.

5.8 POINT-OF-SERVICE. For a client who resides outside their eCounselor’s state of residence and professional licensure, there is an important issue that should be understood by clients before counseling begins. The issue is this: By utilizing these counseling services, they client agrees that he or she is soliciting the services of a professional outside of his or her state of residence. By doing this, the client agrees that the “point-of-service” of counseling is to occur in the counselor’s state of residence and licensure, not the clients. In essence, the client is using the telephone or the Internet (the “information highway”) to virtually travel to the counselor (the counselor’s state of professional practice). Hence, counselors are accountable to and agree to abide by the ethical and legal guidelines prescribed by their state of licensure and residence. By agreeing to solicit the counselor’s services, the client agrees to these terms. If you do not understand, or have any questions regarding this issue, please feel free to ask the counselor about this issue, or contact eCounseling.com support at support@ecounseling.com

5.9 ADDITIONAL CONSENT. This document reflects a minimum amount of informed consent between client and counselor. However, a counselor may have additional information to present to a client as part of a more in-depth informed consent process. This additional information should be presented at the beginning of the counseling relationship and process.

5.10 MODIFICATION & CONFLICT RESOLUTION. It is agreed that any disputes or modifications of agreement shall be negotiated directly between the parties (the client and counselor). If these negotiations are not satisfactory, then the parties agree to mediate any differences with a mutual acceptable third-party mediator, considering first either the Executive Director or Associate Director of the practice. If these are unsatisfactory, then the parties shall move to arbitration, and then binding arbitration, choosing an arbitrator mutually agreeable to both. Litigation shall be considered only if and after all of these methods of resolution are given a good faith effort and are unsatisfactory.

5.11 Informed Consent Agreement We, the undersigned counselor and client, have read, discussed together, and fully understand this agreement and the stated policies. We agree to honor these policies, including the commitment to negotiate and mediate as stated above, and will respect one another’s views and differences in their outworking. We have also agreed to an initial definition of professional work and to the fee to be paid by the client.

SECTION 6 – MISCELLANEOUS PROVISIONS

6.1 Counselor agrees to mail a signed copy of this document, and copies of license information and liability insurance information prior to being listed on eCounseling.com or allowed to use any eCounseling.com services.

6.2 Counselor has read and agrees to eCounseling.com user agreement (terms and conditions) and privacy policy.

6.3 This Agreement shall be governed by and shall be construed in accordance with the laws of the State of Virginia.

6.4 This Agreement constitutes the entire agreement between the parties pertaining to its subject matter and it supersedes all prior contemporaneous agreements, representations and understandings of the parties. eCounseling.com maintains the right and privilege to amend or discontinue this agreement at any time.