Forms

Confidentiality Policy

Your privacy is important to us, and we believe that counseling and therapy is most effective when individuals feel comfortable speaking openly with their therapist. We hope this information will clarify our privacy policies.

In the usual course of events, you have the right to keep your therapy here completely private. This means that, without your written permission, no information about your contact with us is available to anyone outside of this agency, including any personnel, parents, family members, friends, or outside agencies. We do use an electronic medical record. However, although your therapist has access to your medical information, notes written by your counselor cannot be viewed by any staff. Please ask us if you have any questions about this, as we want to be sure you are comfortable with our practices.

There are certain exception to confidentiality, noted below, with which you should be aware before you enter into a therapeutic relationship. Please read carefully through these exceptions, and be sure to ask your therapist if you have any questions.

Exceptions to Confidentiality

1. If appropriate, your counselor may consult with your treating physician or other healthcare provider to coordinate your care with appropriate confidentiality agreements;

2. If you pose a threat of harm to yourself, to another person, or to the community, we will take whatever steps are required by law, or permitted by law, to help prevent the potential harm from happening. This may include contacting your family and/or police officials;

3. In the event of a psychiatric hospitalization;

4. If you report information indicating that a child, disabled, or elderly person is suffering abuse or neglect;

5. A court order, issued by a judge, could require us to release information contained in your records, or could require a therapist to testify;

6. If you have been mandated by an official agency for an evaluation.

All forms are required to be completed and sent back to The Telos Project via email or Fax at the number of 682-708-3775 in order to provide psychological services.  Please call us at 682-841-1475 if you have any difficulties.

Please bring with you the forms needed or arrive 15 minutes early to complete them.

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