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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 on-line
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., on-line 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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