Center for Ethical Practice

Continuing Education & Ethical Resources For Mental Health Professionals

Continuing Education & Resources
for Mental Health Professionals

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Informed Consent For Clinical Consultation (Consultant-Consultee Contract)

Letterhead

Contract for Clinical Consultation

I wish to receive consultation services from _____________________.

I understand that these consultations do not constitute clinical supervision and that I remain completely responsible – ethically and legally – for the decisions I make in my own clinical case situations. My consultant will provide me with an opportunity to discuss clinical cases and issues about which s/he may have some expertise, and s/he may help me consider options for responding, but the comments made for my consideration are not supervisional mandates.

I also understand that although we may sometimes need to discuss personal issues that may be relevant to my clinical work, these consultation services do not constitute psychotherapy.

I understand the potential limits of the confidentiality of this relationship. To the extent possible, my case presentations will provide no identifiable patient information. However, I understand that if I provide identifiable information about a situation regarding which my consultant has an ethical or legal obligation to report confidential information, s/he will inform me at the time and will give me the opportunity to make the report myself.

I understand that if my consultant becomes aware that s/he knows or has a prior relationship with the presented client(s), or if she believes she has a potential conflict of interest in her relationship with me, she will notify me of that fact immediately and will cooperate in helping me find a different consultant.

I agree to the fee of $_________ per one-hour consultation session, payable at each meeting.

_______________________________________________
(Name of Consultee — please print)

_________________________________________
(Signature)

___________________
(Date)

*NOTE: This is a sample form, designed for training purposes.
For use in your own setting, this form must be personalized
to reflect your actual policies.

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Upcoming CE Workshops

  • Should I Write it Down?: Ethical and Legal Ramifications of Documentation Decisions
    • Wednesday, April 5, 2023
    • Fairfax Virginia
  • Should I Write it Down?: Ethical and Legal Ramifications of Documentation Decisions
    • Wednesday, April 26, 2023
    • Zoom Interactive Workshop
  • Boundaries and Dual Relationships: Where Can We Go Astray, and Why?
    • Monday, May 15, 2023
    • Zoom Interactive Workshop
  • What Sort of Problem Is This: Ethical, Legal, Clinical, or Risk Management?
    • Thursday, June 8, 2023
    • Zoom Interactive Workshop

CE Courses Are Approved By:

continuing education for American Psychological Association The Center for Ethical Practice is approved by the American Psychological Association (APA) to sponsor continuing education for psychologists. The Center maintains responsibility for this program and its content.


continuing education for National Board for Certified Counselors (NBCC) The Center for Ethical Practice has been approved by National Board for Certified Counselors (NBCC) as an Approved Continuing Education Provider (ACEP No. 6768). The Center is solely responsible for all aspects of the programs. Programs that do not qualify for NBCC credit are clearly identified.


continuing education Association of Social Work BoardsThe Center for Ethical Practice (provider 1287), is approved as an ACE provider to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Regulatory boards are the final authority on courses accepted for continuing education credit. ACE provider approval period: 3/21/2021-3/21/2024.

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Tel: 434-971-1841 • E-Mail: Office@CenterForEthicalPractice.org