Clinical Consultation Agreement

Please review the following information and sign to attest to your agreement below.

I wish to receive consultation services from Leigh Anne Clark, LCSW of Oakview Therapy, PLLC.

I understand that these consultations do not constitute clinical supervision and that I remain completely responsible – ethically and legally – for the decisions I make in my own clinical case situations. 

My consultant will provide me with an opportunity to discuss clinical cases and issues about which she may have some expertise, and she may help me consider options for responding, but the comments made for my consideration are not supervisional mandates.

I also understand that although we may sometimes need to discuss personal issues that may be relevant to my clinical work, these consultation services do not constitute psychotherapy. Consultee will maintain their own professional liability insurance coverage at all times. Consultee will not be covered by the consultant’s liability insurance. Consultant is not the employer or supervisor of the consultee. Consultee will maintain licensure or certification in state or province of practice appropriate to their training. 

I understand the potential limits of the confidentiality of this relationship. To the extent possible, my case presentations will provide no identifiable patient information. However, I understand that if I provide identifiable information about a situation regarding which my consultant has an ethical or legal obligation to report confidential information, she will inform me at the time and will give me the opportunity to make the report myself.

I understand that if my consultant becomes aware that she knows or has a prior relationship with the presented client(s), or if she believes he has a potential conflict of interest in her relationship with me, she will notify me of that fact immediately and will cooperate in helping me find a different consultant.

I agree to the fee of $120 per one-hour consultation session, payable at each meeting. I understand that if I schedule a consultation appointment and either do not show for the appointment or cancel with less than 24 hours, I will still be responsible for paying the full fee of the appointment.

Please contact me via email to see about scheduling a clinical consultation. I provide consultations for OCD. Consultations are 60 minutes long and $120. I utilize both ERP and I-CBT modalities. Please read the form below after scheduling your consultation and sign the form. Payment is due at time of consultation.