I understand that phone and email sessions have limitations compared to in-person sessions, among those being the lack of "personal" face-to-face interactions, the lack of visual cues in the therapy process, and the fact that most insurance companies will not cover this type of therapy. I understand that although attempts will be made to secure phone, email, and internet chat, that there can be no assurance of their security.

I understand that telephone/email/internet counseling/psychotherapy with MyNewCounselor.Com and/or Caren A. Wright B.A.C.C., is not a substitute for medication under the care of a doctor and/or psychiatrist. I understand that telephone counseling sessions, e-mails and/or internet chat therapy are not appropriate if I am experiencing a crisis or having suicidal or homicidal thoughts. If a life-threatening crisis should occur, I agree to contact a crisis hotline such as 1-800-SUICIDE (1-800-784-2433), call 911, or go to a hospital emergency room.

I understand that privacy will be maintained in all counseling/therapy with MyNewCounselor.Com and/or Caren A. Wright B.A.C.C., except where noted in the Privacy Policies, or as required by law. Among those situations where confidentiality will be breached include where MyNewCounselor.Com and/or Caren A. Wright B.A.C.C. determines there is a significant risk of hurting yourself or someone else. I also understand that MyNewCounselor.Com and/or Caren A. Wright B.A.C.C., follows the laws and professional regulations of the State of Colorado (USA) and the psychotherapy treatment will be considered to take place in the State of Colorado (USA). I attest to the fact that I am 18 years of age or older. A written copy of the General Disclosure & Privacy Policy and Information Release Authorization Form, and additional disclosures can be obtained by downloading them from this site, or by contacting Caren A. Wright B.A.C.C. by calling (970) 593-2552.

General Disclosure Statement & Privacy Policy

1. I Caren A. Wright, obtained my Bachelor of Arts degree in Professional Counseling from American Christian College and Seminary in Oklahoma City, Oklahoma. In addition, I am now perusing my Master of Science degree in Psychology.

2. The Colorado Department of Regulatory Agencies has the general responsibility of regulating the practice of licensed psychologists, licensed social workers, licensed professional counselors, licensed marriage and family therapists, licensed school psychologists practicing outside the school setting and unlicensed individuals who practice psychotherapy. The agency within the Department that has responsibility for licensed and unlicensed psychotherapists is the Department of Regulatory Agencies, Mental Health Section - 1560 Broadway, Suite #1340 - Denver, Colorado 80202. (303) 894-7766

3. Client Rights and Important Information:

a. You are entitled to receive information from me about my methods of therapy, the techniques I use, the duration of your therapy (if I can determine it), and my fee structure. Please ask if you would like to receive this information.

b. You can seek a second opinion from another therapist or terminate therapy at anytime.

c. In a professional relationship (such as ours), sexual intimacy between a therapist and a client is never appropriate. If sexual intimacy occurs, it should be reported to the Department of Regulatory Agencies, Mental Health Section.

d. Generally speaking, the information provided by and to a client during therapy session is legally confidential if the therapist is a licensed social worker, a licensed marriage and family therapist, a licensed professional counselor, a licensed psychologist, or an unlicensed psychotherapist. If the information is legally confidential, the therapist cannot be forced to disclose the information without the client's consent.

Information disclosed to a licensed social worker, a licensed marriage and family therapist, a licensed professional counselor, a licensed psychologist, or an unlicensed psychotherapist, is privileged communication and cannot be disclosed in a court of competent jurisdiction in the State of Colorado without the consent of the person to whom the testimony sought relates.

There are exceptions to the general rule of legal confidentiality. These exceptions are listed in the Colorado statutes (see State Grievance Board Rule 12(e) and C.R.S. 12-43-218, in particular). You should be aware that, except in the case of information given to a licensed psychologist, legal confidentiality does not apply in a criminal or delinquency proceeding. There are other exceptions that I will identify to you as the situations arise during therapy.

4. Moreover, you understand that Caren Wright offers her services independent from WebCard Systems. Therefore, you hereby agree to hold harmless MyNewCounselor.Com and (WebCard Systems - Credit Card Processor & Website Mangers) and all it's staff, from any and all liabilities that may arise from any counseling sessions performed by her. Whereas, it is noted that all counseling services performed by Caren Wright is the independent opinion of herself.

5. If you have any other questions, or if you would like additional information, please feel free to ask.

_____________________________________
(Signature of Participant & Date)

Information Release Authorization Form
(Note: Not all clients will be required to sign this document. Ask for details)

I, ___________________________________________________________________________,
(Name of Client)

Authorize, ____________________________________________________________________,
(Name or general designation of program making disclosure)

To disclose to _________________________________________________________________,
(Name of person or organization to which disclosure is to be made)

The following information: ________________________________________________________

______________________________________________________________________________

______________________________________________________________________________
(Nature of the information, as limited as possible)

I understand that my records are protected under the Federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2, and cannot be disclosed without my written consent unless otherwise provided for in the regulations. I also understand that I may revoke this consent at anytime in writing except to the extent that action has been taken in reliance on it, and that in any event this consent expires automatically as follows:

______________________________________________________________________________
(Specification of the date, event, or condition upon which this consent expires)

________________________________
(Signature of Participant & Date)

_____________________________________________
(Signature of parent, guardian, or authorized representative, if required.)