The following is my counseling contract.
If we need to execute a counseling agreement, I will tell you when you call.
I MUST receive a signed copy of this document in order to enter into any long-term or significant counseling arrangements. I apologize, but this is entirely necessary to protect BOTH of us from litigious and unscrupulous practices. Please do NOT print this screen, but obtain a PDF copy of the document if you need to send it (you need Adobe Reader or a PDF reader to view / print the document). YOU DO NOT NEED THIS CONTRACT MERELY TO CALL.
This ministry is entirely supported by book sales and other
Pastoral Counseling Contract
I, ________________________________________________ being duly sworn, and either:
Print full name of client clearly
[_______] Of consenting age, being of the age of 18 years or older,
Initial in all spaces that apply
[_____] Having the consent of an adult [______] Parent or [______] guardian,
Initial in all spaces that apply
Do hereby give my consent to be counseled by David J. Todeschini.
I understand that all information that is disclosed in counseling is sacrosanct, and is protected by minister / penitent privilege under the Constitution of the United States of America.
I further understand that the counselor and his assignees are to be held completely harmless at law for any and all harm that may be incurred as the result of this counseling, or events surrounding the consultation. I understand that the counselor is NOT an attorney, and I may not request or obtain legal advice or counsel through this counseling.
I give my permission to the counselor to digitally record and archive our conversation for reference purposes, and understand that I will be informed if a recording is in process. Furthermore, I understand that the archived recordings are also confidential, and may not be subpoenaed or entered into evidence in a criminal or civil proceeding due to the provision in the law of "reasonable expectation of privacy".
The signee to this agreement should be aware of the following:
· PRIVACY CONSIDERATION: If you use a wireless handset telephone or a cellular phone, your conversation can be monitored by anyone who is capable of receiving the radio signal.
ADMISSIBLE EVIDENCE CONSIDERATION: Some courts have ruled that intercepted conversations that are broadcast through the public airwaves are "fair game", being that a "reasonable expectation of privacy" is arguable in such cases.
· ONGOING CASE CONSIDERATION: While your conversation may not involve legal advice per se’, you should be very careful of telephone conversations in which you will be discussing the facts or circumstances of a pending legal case.
If your case involves LEGAL considerations, please consult with your attorney before entering into consultation.
I have read and fully understand the terms and conditions of this agreement. I understand the risks involved (if this is a legal case or potential / pending legal case), and I am willing to take those risks.
This document contains the entire agreement between us, and amendments to this agreement can only be made in writing with the consent of both parties.
To this end, I affix my signature.
Signature of client Date
Signature of witness Date
Signature of parent / guardian if client under 18 Date
David Todeschini Date
Signatures are Nunc pro Tunc per: Raynor Vs. Raynor
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