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Agreement

Please read the agreement below

 

PLEASE READ THE FOLLOWING: BY USING AMY J. WILDER, LCSW, INC. ON-LINE COUNSELING SERVICES YOU ARE INDICATING YOUR UNDERSTANDING AND AGREEMENT TO THE FOLLOWING TERMS AND CONDITIONS:

You certify that you are 18 years of age or older. If you are not an adult, your parent or guardian must consent in advance to the use of Amy J. Wilder, LCSW, Inc. on-line counseling services;

You certify that you are the authorized user of a credit card in your name;

Amy J. Wilder, LCSW, Inc. shall not be liable for any claim of loss or damage arising out of the use of online counseling services;

You certify that you are not suicidal and/or self-destructive. If you become suicidal and/or suicidal you will contact the appropriate resources for help. You understand emergency intervention by Amy J. Wilder, LCSW, Inc. is not possible; Suicide Resources Here

You certify that you are not under the influence of alcohol or drugs during the intake process or on-line counseling session; Alcohol and Drug Information here

If you are already working with another counselor you certify that you will notify that counselor on intent to use AMY J. WILDER, LCSW, INC., online counseling services;

You certify that you are not misrepresenting yourself or your issues, which would undermine the integrity of AMY J. WILDER, LCSW, INC., on-line counseling services;

If your issues would be better discussed face-to-face in an office we will help by making a referral; see other referral sources You attest to the understanding that on-line counseling services is not meant to deal with serious mental health illnesses and is not appropriate for all people seeking help;

You understand that it is difficult to insure complete privacy on the Internet and you have read the privacy statement and have a general understanding that there are some limits regarding privacy on the Internet.

If you have any questions or concerns regarding this Agreement please share them with me: amylcsw2@aol.com

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IF YOU ARE IN CRISIS OR SUICIDAL NOW…

Most of us experience suicidal thoughts at different points in our life. For some people, suicidal thoughts are a daily experience. If you are having suicidal thoughts, seek treatment in your local area immediately. The most helpful thing that AMY J. WILDER, LCSW, INC. can do for you is to insist that if you do not feel safe you must contact one if not all of the following:

  • National Crisis Helpline – for use in locating the nearest crisis services in the US – 1-800-999-9999
  • American Assoc. of Suicidology – 1-800-SUICIDE (784-2433)
  • Dial 0 for the operator and ask for:
    • suicide prevention
    • crisis intervention
    • community crisis center
    • county or community mental health center
  • or Call 911

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Alcohol and Drug Abuse Referrals

  • Cocaine National Hotline – 1-800-COCAINE (262-2463)
  • National Council on Alcoholism – 1-800-622-2255

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Hotlines and Help Lines

  • National Domestic Violence Hotline 1-800-799-SAFE
  • Child help USA 1-800-4-A-CHILD
  • Child Abuse National Hotline 1-800-25-ABUSE
  • Elder Abuse Hotline 1-800-252-8966
  • National Alliance for the Mentally Ill 1-800-950-NAMI
  • National Runaway Switchboard 1-800-621-4000
  • SAFE (Self-Abuse Finally Ends) 1-800-366-8288
  • Youth Crisis Hotline 1-800-448-4663
  • Gambling Hotline 1-800-749-2673

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