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consultation-agreement-10

Consultation Agreement

Notes on Gender Role Transition
Anne Vitale PhD, Editor

PERMISSION TO PROCEED

PRIVATE INDIVIDUALS: I understand that I am paying Anne Vitale PhD for personalized educational information via electronic communication regarding gender identity/crossdressing issues. If you are a private individual who just wants to know more about gender identity issues for yourself or someone close to you or wants a more personal understanding of what I have written elsewhere in this site and agree to the limits of confidentiality I have outlined below, then by all means proceed.

However, if you are feeling overwhelmed by your gender issues,and feel you need psychotherapy, contact me at anne@avitale.com and I will either make an appointment to see you in my office in San Rafael, California or, if the distance from you to my office is prohibitive, I will do the best I can to try to find a gender specialist in your area.
LICENSED PROFESSIONALS: I understand that I am paying Anne Vitale PhD for advice regarding either a particular client (who's confidentiality shall be maintained so please no specific names) or for those providers who want to expand their general knowledge of working with this population.
TERMS OF EXCHANGE: All payment shall be in US Dollars and consultation shall be conducted in English. Once payment is received, Dr. Vitale will contact the interested party by email in order to set up a mutually agreed upon phone meeting time. Please be mindful that Dr Vitale lives on the West Coast of the Untied States and is on PST.
CONFIDENTIALITY: Preserving my clientÕs privacy is a basic tenet of my practice. However, I need to advise you of the legal and ethical exemptions to confidentiality in the State of California. Confidentiality may be waved under the following circumstances:
The licensed mental health provider has reasonable cause to believe that the client is a danger to him or herself and disclosure is necessary to prevent harm
The licensed mental health provider has reasonable suspicion of child abuse and is therefore, mandated to inform Child Protective Services.
The licensed mental health provider has reasonable suspicion of dependent adult or elder (65 or older) abuse and is therefore mandated to notify Adult Protective Services.
The client makes a serious threat of physical harm to an identifiable victim. In such a situation, the licensed mental health provider is mandated to notify both the intended victim and the police.
If I believe that any of the above exceptions to confidentiality exist and there is sufficient time, I will make every effort inform you of my intentions before making a disclosure.

I have read Dr. Vitale's consultation policy statement and agree with its terms.

I have read Dr. Vitale's consultation policy statement and do not agree with it's terms.

Copyright¬© 2006-2022 Anne Vitale PhD avitale.com All right reserved

DISCLAIMER: 

Nothing on this site should be viewed as providing therapeutic advice. No formation of a client/therapist
relationship with Dr. Vitale is intended or to be implied or inferred. The information provided in this site is for educational
purposes only. I attempt to keep the information current but make no representation or warranties in that regard. You should
not rely upon this information as a substitute for consul with a qualified mental health professional.