(1) Certified counselors and certified advisers must provide a disclosure statement to each client prior to starting a program of treatment.

(2) The following must appear in the disclosure statement:

(a) The name of the certified counselor or certified adviser and the name of their firm, agency, or business, if any.

(b) The certified counselor's or certified adviser's business address and telephone number.

(d) The certified counselor's or certified adviser's education, training, and experience.

(e) The name and description of the types of counseling provided by the certified counselor or certified adviser, including the therapeutic orientation, methods, and techniques employed in their practice, and a list of resources relevant to the therapeutic orientation.

(f) The type and duration of counseling expected, if known at the time of providing the disclosure information.

(g) Fee information, including:

(i) The cost for each counseling session;

(ii) Billing practices, including any advance payments and refunds;

(iii) A statement that clients are not liable for any fees or charges for services rendered prior to receipt of the disclosure statement.

(h) The limits of confidentiality under RCW 18.19.180.

(i) Disclosure of the certified counselor's or certified adviser's supervisory or consultation agreement as defined in WAC 246-810-025.

(j) Disclosure that the certified counselor or certified adviser is not credentialed to diagnose mental disorders or to conduct psychotherapy as defined in WAC 246-810-010(14).

(k) All of the following:

(i) Counselors practicing counseling for a fee must be credentialed with the department of health for the protection of the public health and safety.

(ii) Credentialing of an individual with the department of health does not include a recognition of any practice standards, nor necessarily imply the effectiveness of any treatment.

(iii) The purpose of the Counselor Credentialing Act, chapter 18.19 RCW, is to:

(A) Provide protection for public health and safety; and

(B) Empower the citizens of the state of Washington by providing a complaint process against those counselors who would commit acts of unprofessional conduct.

(iv) Clients have the right to choose counselors who best suit their needs and purposes.

(l) A copy of the acts of unprofessional conduct in RCW 18.130.180 and the name, address, and contact telephone number within the department of health for complaints.

(m) Signature and date blocks for the client, and the certified counselor or certified adviser, including an attestation that the client agrees that the required disclosure statement has been provided and that the client has read and understands the information.

PDFWAC 246-810-031

Disclosure statement to be provided to clients by certified counselors and certified advisers.