Records of your health care services are kept safely locked away. You may ask to see and/or copy
your record by making an appointment specifically for that purpose. You may also ask your
psychologist or counselor to correct your record. The information in your record is confidential,
and will be disclosed to no one without your written consent, unless the law allows otherwise.

In addition, when clients enter couples or family therapy, their right to confidentiality from each
other is waived. It is not advisable for the therapist and one partner or family member to hold
confidential information from the other partner or family members. This does not mean that
information will automatically be shared. However, clients will be strongly encouraged to share
pertinent information as necessary to augment the therapy process. A culture of secrecy disrupts
the effectiveness of couples and family therapy. Thus, if you choose to have a partner or family
member participate in therapy, either individually or conjointly, you will be voluntarily waiving
the right to confidentiality with them. Do not tell me anything you wish kept secret from your
partner or family members, as I reserve the right, at my discretion, to share any information I
deem helpful to the therapy.

Clients seen in marriage counseling do not hold the confidentiality privilege individually since the
couple is the client.  Therefore, any waiver of the privilege must be given by both the husband and

Anything discussed in therapy, and all information obtained from any source, including the fact
that you are my client, is confidential.  However, confidentiality is not absolute and there are
circumstances in which information can or must be released.

Under certain circumstances certain information may or must be revealed or released to others.
The following are examples of exceptions that may apply:
Client Confidentiality
1. If the client, (or a dependent child), is in immediate danger to himself or others the law
demands that the therapist acts to protect the life of the client and/or dependent child. This may
require notification of family or other appropriate persons.

2. If the client threatens harm to another person, and there is a possibility of injury or death,
the law demands that the therapist acts to protect the lives of potential victims. This may
require various appropriate interventions, including informing the police and the potential

3. If the client reports his/her behavior or action against a child, elder, or other dependent adult
which is considered abuse, including physical violence, neglect, and/or sexual molestation, or if
the client reports such acts by another, the law mandates that the therapist must make a report
of suspected abuse to the legal authorities.

4. If the client is involved in legal action where he/she places his/her psychological condition
before the court, the client forfeits his/her right to confidentiality in matters before the court. In
such cases, the therapist will attempt to discuss the situation with you in order to clarify and
seek alternatives.

5. You should always be aware that most insurance agreements require you to authorize me to
provide a clinical diagnosis to the insurance company. Sometimes additional information such
as a treatment plan or summary, or in rare cases, a copy of an entire record, may be requested.
This information will become part of the information required to be released to the court.

6. If your psychologist is subpoenaed and ordered to testify in a court of law and their
objections are overruled. This happens in very few instances and typically occurs in legal
proceedings involving child custody, law suits in which services you received are considered to
be evidence in a court of law, or charges involving certain types of criminal behavior.

7. If you request that your counselor or therapist communicate with someone, you will
normally be asked to sign a "Release of Information" and to specify what can be communicated
and for how long the release will remain in effect.

8. If during a medical emergency your therapist or counselor needs to reveal information that
is necessary to protect or insure your health and safety. They can only release that information
necessary to protect or insure you health and safety.

9. If your therapist or counselor must take action to collect a debt incurred for services, your
name and the amount of your debt may be revealed to a collection agent.

10. If you are told that you are not a client or patient or if the professional tells you that your
communication if not confidential.

11. If you are a minor, or a minor that is not emancipated, a therapist or counselor may be
required to advise or involve your parents or guardian in your treatment. There are
circumstance in which a psychotherapist is not required to notify the parents of a minor.
Click On This Sentence To Read About Our Privacy Practices
Office:  (770) 729-0123
Serving Georgia in Atlanta and the suburbs of
Alpharetta, Dunwoody, Sandy Springs, Roswell, Norcross, Dacula, and Johns Creek.