Informed Consent for Kent Schornack, LISW, MA

Professional Information:  I am a Licensed Independent Social Worker (L.I.S.W.) in the State of Iowa, and have both a Master in Social Work degree from the University of Iowa and a Master of Arts degree in Biblical Counseling from Colorado Christian University.  I have over 25 years of experience in counseling and social work, working with children, families, couples, and adults with a variety of concerns.  I use an eclectic approach to counseling, which takes into account spiritual, psychological, social, and biological aspects of the client. 

Counseling Relationship:  I believe counseling is a process whereby a client seeks to resolve interpersonal, emotional, and/or spiritual difficulties with the assistance of caring professional.  As your counselor I will bring to the sessions my professional knowledge and experience, but the ultimate responsibility for growth and change rest with you, the client.  Therapy can last from a few weeks to several months.  We will be in ongoing dialogue about your needs, progress, and recommended duration of therapy.  You are invited at any time to ask questions about my methods or the direction of your counseling.  If for any reason you are dissatisfied with my services, please let me know and I will try to resolve your concerns.  If we are unable to resolve your concerns, I will be available to assist you in finding qualified help elsewhere. Occasionally, I may elect to discontinue therapy.  This usually happens when I feel no substantial progress is being made or other factors are interfering with my ability to help you. 

Confidentiality:  Under normal circumstances everything you discuss with me will be held in strict confidence.  However, you should be aware that there are some situations in which I may be required to report information to the proper authorities and/or an appropriate family member without your permission.  If I believe there is risk that you might harm yourself or someone else, I will be required to contact the authorities, a family member or friend, or the person being threatened, to give them the opportunity to protect you, and or him/herself.  I am also mandated by the state of Iowa (State Law, Code Section 232 & 235) to report suspected incidents of child and/or dependent adult abuse.  If you become involved in any legal issues in which you mental health is an issue (for example, child custody disputes or an injury lawsuit resulting in emotional pain/suffering) I may also be required to disclose information in response to a subpoena issued by a court of law.  If you are utilizing third party payment, your insurance company will need access to certain information including (but not always limited to) your diagnosis and dates of your visits. I will discuss these circumstances with you if they arise, and I will only disclose essential information when required.  Finally, you should be made aware that I consult regularly with other professionals regarding clients with whom I am working.  This allows me to gain other perspectives and ideas as how to best help you reach your goals.  Such consultations are obtained in a way that complete confidentiality is maintained. 

Sessions, Fee, and Cancellations:  Counseling sessions last approximately 60 minutes.  The initial assessment session(s) fee is $154, and all sessions following are $150.  For those not utilizing insurance, fees may be adjusted for financial hardship.  It is expected that you pay the fee at each session.  If you have insurance coverage, your co-pay is due at the time of your visit.  If there is a problem collecting payment from your insurance company, you are personally responsible for payment of any remaining balance.  If I am not a provider with your insurance company, I will be happy to provide you with receipts and any other information needed so that you may submit your own insurance claims and be reimbursed by your carrier.  If you need to cancel an appointment, you must notify me with 24 hours of that appointment.  Please call my office at 515-210-6803 to leave a message of your cancellation.  I have reserved your appointment expressly for you; failure to notify me within 24 hours will result in you being charged $50 for the missed appointment.  I understand that occasionally emergencies do arise.  If this is the case, please contact me as soon as possible to inform me of the reason for the lack of 24 hour notice to discuss your situation.

Appointment & Emergencies:   Appointments can be made following each session, or you may call 515-210-6803 to schedule. Voice mail is confidential and is checked regularly.  If you have an emergency and it is after hours please call 911, or pursue 24 hour assistance from a local emergency room, shelter, or police department.

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