Counselor Disclosure Form
Maggie Metcalfe Counseling
Margaret Metcalfe, MA VRC LMHCA
WA License #MC 61023847
PO Box 287 Acme, WA 98220
Maggie Metcalfe Counselor Disclosure Statement
The counseling I provide comes from a background in Rehabilitation Counseling-which is focused on helping clients reach their personal goals even when faced with disabling conditions such as mental and physical health challenges. I work with clients to discover their goals and motivations and to accomplish their career, relationship and independent living goals through a counseling process.
I use a holistic, person-centered approach with a special focus when there are disabling conditions that cause barriers to a client's personal progress and goals. I address mental health, cognitive conditions including brain injury, autism, physical conditions, personal development, educational and occupational development.
I have a Bachelor's degree in Fine Art and a Master's degree in Rehabilitation Counseling. I have 7 years of experience as a Vocational Rehabilitation Counselor and a further 6 years as a Vocational Rehabilitation Technician. I have 16 years experience as a foster parent for therapeutic level teen youth and over 20 years as a self employed tradesperson and some of those years overlap.
If for any reason I am not able to continue as your counselor I will provide you with referrals to other counselors at your request. For quality assurance purposes I will talk with my supervisor, Jeremy Hulley, MA, LMHC, SEP about your case.
My fee for counseling services is $90.00/hour and is due at the time of service.
There are some instances when I am required by law to report (with or without your consent) to a law enforcement agency. If this happens I will inform you at the time. Those exceptional situations that I must report:
1. If I have good reason to believe that you will harm another person, I must attempt to inform that person and warn them of your intentions. I must also contact the police and ask them to protect your intended victim.
2. If I have good reason to believe you are abusing or neglecting a child or vulnerable adult, or if you give me information about someone else who is doing this, I must inform Child Protective Services or Adult Protective Services as soon as possible, but no later than 24 hours from becoming aware of an incident.
3. If I believe that you are in imminent danger of hurting yourself. I will try to contact a member of your support system and/or call the police or the county crisis team.
If you are not satisfied for any reason with the services you receive from me let me know, or ask to talk with my supervisor so we can take steps to resolve the problem. The Washington Department of Health Complaint process is online at https://fortress.wa.gov/doh/opinio/s?s=ComplaintFormHPF or call 360-236-4700 for information.
I do not communicate or accept friend requests from clients on social media.
I have read this disclosure statement and have been given the opportunity to ask questions about its’ contents.
Signature of Customer Date
Margaret Metcalfe, MA VRC LMHCA Date
This statement meets the requirements for a counselor professional disclosure statement as required in the Code of Ethics, effective January 1, 2010, of the Commission on Rehabilitation Counselor Certification and the requirements of RCW 18.225.100