Professional Disclosure Statement, Disclaimer & Privacy
Professional Disclosure Statement
Welcome
Choosing to pursue counseling as a means of addressing areas of concern in your life marks an important initial step toward improving your well-being and life satisfaction. While therapy is inherently variable and outcomes cannot be guaranteed, my commitment is to provide you with effective strategies and insights that may support your efforts to set objectives and develop approaches for enhancing your emotional, relational, mental, and physical health.
Educational and Professional Background
My name is Angela Sullivan, and I am licensed as a Licensed Professional Counselor in Missouri and as a Licensed Clinical Professional Counselor in Kansas. Additionally, I hold Certified Reciprocal Advanced Alcohol and Drug Counselor (CRAADC) certification in Missouri and am a certified mediator for the state. I am an active member of the American Association of Christian Counselors (AACC), and I practice from a Christian perspective. My academic credentials include a bachelor’s degree in psychology from Wichita State University (1998) and a master’s in Counseling and Guidance with a concentration in Marriage and Family Counseling from the University of Missouri–Kansas City (2004). Mediation certification was acquired in Missouri in August 2014.
Ethical Standards
My practice adheres strictly to the American Counseling Association’s Code of Ethics and relevant statutory regulations as outlined by the Missouri and Kansas legislatures and the Missouri Substance Abuse Counselors Certification Board. I also follow mediation ethics established by the State of Missouri.
Therapeutic Services Offered
I work collaboratively with individuals, couples, and families seeking guidance in navigating life challenges. Common topics addressed include stress management, anxiety, depression, familial and relationship concerns, body image, career guidance, marriage issues, substance abuse, divorce recovery, co-parenting, mediation, eating disorders, and spiritual matters.
The therapeutic relationship is defined by both intimacy and professionalism. It is essential to maintain appropriate boundaries; therefore, the therapist’s role is exclusively to serve as your health-care provider, not as a personal acquaintance. Gift-giving and bartering are not considered suitable within this context. All payments should be rendered as detailed in the “Fees” section under Practice Policies.
Regarding public interactions, confidentiality remains paramount. In instances where we encounter one another outside of sessions, I will not initiate contact, but you are welcome to do so if you wish. I will refrain from disclosing any information about our association.
Benefits and Risks of Therapy
Engaging in therapy presents both opportunities and potential challenges. Benefits may include improved coping mechanisms, enhanced interpersonal understanding, and greater self-awareness, all contributing to personal development and contentment.
Therapy can also be challenging and uncomfortable at times. Recalling and resolving distressing experiences can evoke discomfort and may temporarily intensify conflicts or emotions before progress ensues.
I will discuss with you the benefits and risks involved in your situation as we go through the therapeutic process, and I encourage open communication regarding any concerns.
Grievances
Should you have any dissatisfaction with services, please raise these matters directly for prompt resolution. If necessary, we will discuss methods for addressing and/or discontinuing services.
Practice Polices
Fees
All counseling and mediation services must be paid at the time of service.
Employee Assistance Program sessions last 45 minutes; insurance-based sessions range from 45 to 50 minutes, and private pay sessions are 55 minutes. You are responsible for settling your account at each appointment. Please verify your insurance benefits before scheduling and determine whether I am an in-network provider. For out-of-network services, I can supply invoices for submission to your insurer.
Payments are due at the time of service. Accepted payment methods include credit cards, debit cards, and PayPal through my website. Notify me in advance if you must cancel; late cancellations (less than 24 hours' notice) will incur an $80 fee charged to your card. After three missed or late-cancelled appointments, case closure may be considered. It is my responsibility to provide you with appropriate therapeutic services and resources. Your responsibility is to make the most of these services and to pay for them. In the unlikely event that you do not pay for services in accordance with our payment agreement, your account may incur late fees and/or be turned over to a collection agency or legal firm for collection. Any associated fees would be your responsibility.
Standard rates are $150 per 55-minute session. A ten-session package for private-pay clients is available at $1,250 if paid in full, offering $250 savings.
Phone Contact
These conversations need to be kept brief, so as not to interfere with the schedule of other clients or cross the boundary into "phone counseling". Remote counseling may be used in times of a Pandemic or other emergency. You may still be billed for these services. I prefer that you use email for questions or updates.
Please know that if you have information you need to share, you may send me an email. I will let you know I received it and will review it before your next session. I will not be drafting a lengthy email back in response; however, we will discuss your email in the next session. You may leave messages on my voice mail 24 hours a day, 7 days a week at no charge. I will get back to you by the next business day. You may also text me at 816-229-2760 to confirm, make or change your appointment time. Please only use text for setting up and confirming appointments and if there is a change regarding who may be attending.
Internet/ E-mail/Social Media
Remember this is a professional relationship. I am unable to add you as a friend on Twitter, Facebook, etc. due to the Therapist/Client relationship and due to The Association of American Counselors Ethics Regulations.
Other Services Rendered
Court/Legal
Disability paperwork is not provided. If I perceive potential court involvement, I may choose to phase out services. Reports, consultations with another professional (i.e., school staff, Children's Division, GAL, lawyer or other legal representation), or similar activity, including phone and email conversations with you or another professional, will be billed at $250 per hour. If I am asked to testify in court, I require a $2,000 payment per day, as I will have to reschedule clients for the day in court and will have to take time to prepare for testimony. Insurance does not pay for this type of service. There will also be a charge for duplication of records. You will receive a statement with such charges fully outlined.
Emotional Support Animals
ESA letters are available following a 45-minute assessment session. The total charge is $250 for this service.
If you need an invoice for services rendered in the past, there may be a charge, especially if there have been several sessions it can become time consuming for me. If you need to keep track of past appointment dates, charges, etc. I would suggest keeping a calendar or log.
Confidentiality
The law protects the privacy of all communications between client and health-care provider. I can only release information about your treatment to others if you sign a written authorization form that meets certain legal requirements imposed by HIPAA and state law. Mental health records are subject to enhanced confidentiality protocols.
Emergencies
If you have a life-threatening emergency, including feeling like hurting yourself or others, call 911 or go to the closest hospital emergency room, then call me. If it is not life-threatening, I will return your call the next business day.
If you need an emergency session due to crisis, I charge $300 per hour and will have your session scheduled within 24 hours from receiving notice of the need/crisis.
Termination
As we work together, we will set goals, which you wish to accomplish through our work together. We will track your progress and when your goals have been achieved, we will discuss the termination of your therapy. Also, if our work together does not seem productive, it is likely that I may recommend a referral to another therapist. Notice prior to termination is requested to support a healthy transition and avoid a situation that might be therapeutically unhealthy for you. If you have any questions about what you have read on this form, please feel free to ask me to clarify. Thank you for choosing me as your counselor and I am looking forward to collaborating with you!
Please return the signed form below, including card information if applicable.
Other Important Disclosures and Notices
The information at this site is subject to change without notice. Although we try to keep our site current and accurate, you should not rely on this information or its applicability to any specific circumstances without first speaking with a doctor. Changes Counseling and Mediation cannot promise that the information on this site is applicable to your circumstances, correct, complete, and up-to-date, that your access will be uninterrupted, or that material accessible from this site is free of viruses.
Changes Counseling and Mediation does not intend links to be referrals to, or endorsements of, the linked entities or information that they make available. Changes Counseling and Mediation will remove any link from this site upon request from the linked entity. This site is not sponsored or associated with any particular linked entity unless so stated in truth by that entity.
Privacy Policy Statement
Changes Counseling and Mediation has adopted the following privacy policy statement applicable to our web site.
Changes Counseling and Mediation does not currently collect personal identifying information (the "Information") through our web site except:
- for Information that your Internet service provider automatically provides to our web server, such as its web site address and possibly your e-mail address,
- for Information that you send to us in an e-mail message, and
- for Information that you submit to us in a CGI form (for example, when you submit a search request on our web page).
E-mail sent to us may not be secure. If you choose to send us an e-mail message, we may retain the content of the e-mail, your e-mail address and our response, and it becomes the property of Changes Counseling and Mediation.
Changes Counseling and Mediation will use Information for our own proper purposes, but we will not sell Information to third parties.
We encourage you to review the Changes Counseling and Mediation Privacy Policy Statement periodically for updates that will be posted on our web site.