Life Coaching, Spiritual Counseling and Holistic Therapy from Dr. Shariee under Divine Army LLC is available by appointment only. (HIPAA Compliant Partner)
Click this link below to
Fill out intake form and client agreement below after booking.
Overview
This document contains important information about my professional services, Health Insurance Portability and Accountability Act (HIPAA), and business policies. HIPAA is a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. Although these documents are long and sometimes complex, it is very important that you understand them. When you sign this document, it will also represent an agreement between us. All services are to be prepaid.
Services
Appointments will ordinarily be 30-60 minutes in duration, per session at a time we agree on, although some sessions may be more or less frequent as needed. The time scheduled for your appointment is assigned to you and you alone. The Client is responsible for creating and implementing his/her own physical, mental and emotional well-being, decisions, choices, actions and results. As such, the Client agrees that the Coach, Counselor or Therapist is not and will not be liable for any actions or inaction, or for any direct or indirect result of any services provided by the Coach, Therapist or Counselor.
You have the right to considerate, safe and respectful care, without discrimination as to race, ethnicity, color, gender, sexual orientation, age, religion, national origin, or source of payment. You have the right to ask questions about any aspects of services and about my specific training and experience.
Coaching
Client understands that coaching is not therapy. It does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease. Client understands that coaching is not a substitute for professional advice by legal, mental, medical or other qualified professionals. At this time.. I do not treat or diagnosis you. I make recommendations as a trauma-informed coach, pre-licensed counselor, and spiritual counselor.
Client agrees to communicate honestly, be open to feedback and assistance, and create the time and energy to participate fully in the program. Coaching maximizes the Client’s personal and professional potential needs. Coaching facilitates the creation/development of personal, professional or business goals. Coaches develop and carry out a strategy/plan for achieving those goals.
You, the Client acknowledges that coaching is a comprehensive process that may involve different areas of his or her life, including work, finances, health, relationships, education and recreation. The Client agrees that deciding how to handle these issues, incorporate coaching principles into those areas and implementing choices is exclusively the Client’s responsibility.
The Client acknowledges that coaching does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association. Coaching is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals. It is the Client’s exclusive responsibility to seek such independent professional guidance as needed.
Limited Therapy or Counseling
Therapy is a relationship between people that works in part because of clearly defined rights and responsibilities held by each person. As a Client in counseling, you have certain rights and responsibilities that are important for you to understand. There are also legal limitations to those rights that you should be aware of. I, as your therapist, have corresponding responsibilities to you.
Therapy or other counseling has both benefits and risks. Risks may include experiencing uncomfortable feelings, such as sadness, guilt, anxiety, anger, frustration, loneliness and helplessness, because the process of therapy often requires discussing the unpleasant aspects of your life. However, therapy is still beneficial and leads to a significant reduction in feelings of distress, increased satisfaction in interpersonal relationships, greater personal awareness and insight, increased skills for managing stress and resolutions to specific problems. But, there are no guarantees about what will happen. Therapy requires a very active effort on your part. In order to be most successful, you will have to work on things we discuss outside of sessions.
The first 2-4 sessions will involve a comprehensive evaluation of your needs. By the end of the evaluation, I will be able to offer you some initial coaching or counseling suggestions. At that point, we will discuss your goals and create an initial coaching treatment plan. You should evaluate this information and make your own assessment about the direction of your health. If any treatment is outside of my expertise, I be happy to refer you to another mental health professional.
Confidentiality
Confidentiality is an important element of the coaching, therapy or counseling process. Your identity and ongoing work will be kept strictly confidential. I will only release information about our work with your written permission, or if I am required by court order. The following exceptions will apply:
There are a broad range of events that are reportable under child protection statutes. Physical or sexual abuse of a child will be reported to Child Protective Services. Also, elder abuse is also required to be reported to the appropriate authorities.
Inappropriate or Unprofessional Behavior
Any inappropriate and/or unprofessional suggestive behavior will not be tolerated and your coach, counselor or therapist may choose to immediately end the session without a refund. You also have the right to expect that I will not have inappropriate relationships with clients or with former clients. Please contact our office should you have any questions or concerns. Anything outside of the scope of my training.. I will have to refer you to another therapist or counselor.
Attending Sessions Impaired
I will not engage in therapy, counseling or coaching with individuals who appear to be impaired by drugs or alcohol. Please note that if you attend a session and appear to be under the influence of any drugs/medications (legal or illegal) or alcohol, I will ask you to reschedule your session. Session fee will not be refunded.
Payment and Cancellation
I do not accept insurance as payment at this time. The standard fee for the initial intake is $100.00 and each subsequent session is per agreed amount. You are responsible for paying at the time of your session unless prior arrangements have been made. Payment must be prepaid by cash, debit or credit card. Any card transactions returned to my office are subject to an additional fee of up to $25.00 to cover the bank fee that I incur. If you refuse to pay your debt, I reserve the right to use legal resources to secure payment.
Because I operate “By Appointment Only,” give me at least 24 hours notice if you need to cancel or reschedule your appointment, otherwise you will be charged for the session in full. Clients who have pre-paid agree to have the entire hourly fee or session deducted from their pre-payment in cases of no-shows and late cancellations. Other services include emergency phone calls over 15 minutes, generating reports, consulting with other agencies and professionals at your request, and the time spent performing any other services you may request.
Counselor, Therapist, or Coach Availability
I am mainly available by appointment. If emergency present itself, please dial 911. I am often not immediately available by telephone. I do not answer my phone when I am with clients or otherwise unavailable. At these times, you may leave a message on my confidential voice mail and I will return your call as soon as possible. However, it may take a day or two for non-urgent matters. If, for any number of unseen reasons, you do not hear from me or I am unable to reach you, and you feel you cannot wait for a return call or if you feel unable to keep yourself safe, 1) contact your local Community Mental Health Services, 2) go to your Local Hospital Emergency Room, or 3) call 911 and ask to speak to a licensed mental health professional on call.
The Client understands that in order to enhance the coaching, therapy or counseling relationship, the Client agrees to communicate honestly, be open to feedback and assistance and to create the time and energy to participate fully in the program. Services can be provided via office, video chat, phone, text, or email. My aim is to provide a secure and confident connection but please keep in mind that all things aren’t too secure.
Limited Liability
Except as expressly provided in this Agreement, the Coach, Counselor, or Therapist makes no guarantees, representations or warranties of any kind or nature, express or implied with respect to the coaching services negotiated, agreed upon and rendered. In no event shall I be liable to the Client for any indirect, consequential or special damages.
Termination and Record Keeping
Either the Client or the Coach/Counselor/Therapist may terminate this Agreement at any time with one week written notice. Client agrees to compensate me for all services rendered through and including the effective date of termination of the coaching relationship.
I am required to keep appropriate records of the services that I provide. Your records are maintained in a secure location. I keep brief records noting that you were here, your reasons for seeking therapy/counseling/coaching, the goals and progress we set for you. Except in unusual circumstances that involve danger to yourself, you have the right to a copy of your file. You also have the right to request that a copy of your file be made available to any other health care provider at your written request. Please fill out the form below.
