Passion For Souls Transforming Lives Outreach Counseling Policy & Liability Release Form

Method

Information about the various material, counseling methods and structure are available upon request from Passions For Souls Transforming Lives Outreach. Our counseling is faith based, Biblical in nature with cognitive behavior modification trauma techniques to help uncover wounded areas of the soul which are causing significant ongoing trauma physically, emotionally, spiritually and relationally. Length of counseling may extend up to but not surpass 25 weekly sessions unless your counselor deems more. Counselees may end their sessions at any time for any reason. We would like one last session as an exit interview to process next steps.

Lay Credentials

Your counseling will be provided by Eric and/or Annette Howard, lay counselors who shall be under the supervision of the Board of DIrectors of Passion For Soul
Transforming Lives Outreach.

Your lay counselors are NOT professionals on psychological counseling, psychiatric therapy or marriage and family counseling and are not licensed in the state of Iowa as counselors, social workers or therapists. However, they do receive continuing education as Grief & Loss Facilitators, Healing Trauma God’s Way(Road To Discovery),Various Addiction and Recovery Programs & Caregiver Support Facilitator Training.

Confidentiality

The communication between you and your counselor will be considered confidential except to the extent disclosure is required by law or in other instances in which the
counselor learns of potential threats of harm to self or others, including but not limited to cases of child abuse, or neglect, suicide, domestic violence or other violence or physical threats, or homicide. In such instances your counselor will report to the Board Of Directors of Passion For Souls Transforming Lives Outreach and or to appropriate state law enforcement authorities.

Missed Appointments

We request if you know you cannot meet your scheduled appointment that you call within 24 hours in advance if possible. Our counselors are volunteers and travel
extensively and appreciate your respect and cooperation in regards to this matter.

Media Policy

Books and audio or other media materials related to your counseling are available for purchase or loan. Should you choose to borrow, the following policy will apply: “As a condition of counseling, I agree that, to avoid the delay of counseling, I will return borrowed counseling material by the deadline, or I will have to pay for the materials
borrowed.

Disclaimer & Liability Release

This released must be signed and dated prior to participation. Download a copy to sign

I, the undersigned, in consideration of the biblical counseling services provided by Passion For Souls Transforming Lives Outreach, do hereby agree to release,
discharge, indemnify & hold Passion For Souls Transforming Lives Outreach, its counseling ministry, and their biblical counselors, employees, staff, volunteers and
agents harmless from any and all past, present, future known and unknown liability,actions, causes of actions, claims, expenses damages, or injury incurred by me
or my property as a direct or indirect as a result of any counseling services I may receive from Passion For Souls Transforming Outreach, its counseling ministry, or its counselor(s). I have been informed of the nature and purposes of the Biblical-based counseling ministry services. I understand that confidentiality is not guaranteed and that my consent may be revoked orally or in writing to and/ or during my counseling session. Furthermore, I understand that neither the lay counselor(s) to which I am assigned are not licensed in the state of Iowa as professional counselors, social workers, financial counselors or advisors, or therapists and any desired results are not guaranteed as a result of said biblical counseling services. I further understand that it is the specific intent and purpose of this legal binding document to release, discharge, and indemnify for any and all claims and causes of action of any kind or nature that is directed towards Passion For Souls Transforming
Lives Outreach, its counseling ministry, or its counselor(s) in connection with said biblical counseling service or any other associated activities. This includes causes are
known or unknown, specifically mentioned or implied, or neither mentioned nor implied which might exist at or prior to the date of this document.
I further state that I HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND HAVE SIGNED THIS RELEASE AS MY
OWN FREE ACT. This is a legal binding agreement that I have read and fully understand.

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