Piper Warwick, MS,LMHC
PO Box 1145 Pullman WA 99163
509-270-5460
Disclosure Statement (required by WAC 246-809-710)
Before you start counseling, there are some things you ought to know.
Legally, this information is called “Informed Consent.” Informed consent will help you understand what to expect from your experience at our office, and it will explain some limitations to what we will be doing.
The following includes a description of our practice policies and meets the requirements of Washington State Law. Please read and review the following information carefully and ask any questions that you may have. You will be asked to sign a copy indicating that you have been informed of, understand, and agree to these guidelines.
Professional Qualifications:
My name is Piper Warwick. I have a Masters of Science in Counseling
Psychology from Central Washington University, and I am a Licensed Mental
Health Counselor in the State of Washington. My license number is
LH 00008908. I am also a Licensed Professional Counselor in the State of Idaho.
My license number is LCP-3754. Over the years, I have worked in a variety of mental health settings including outpatient day treatment with children, residential treatment with teenagers, inpatient treatment with adults and children, and outpatient mental health.
While I have experience working with numerous types of issues and concerns, I specialize in work with the children and teenagers- especially those dealing with anxiety, PTSD, depression, anger, body image issues and selfesteem. When working with children and teens, I find it best to incorporate family members into the therapy at times, since a young person’s world is greatly influenced by their environment and those in their immediate world. Often the majority of counseling will be done on an individual basis, with family and couples sessions arranged as appropriate.
I also specialize in working with adults with anxiety and trauma issues and have been certified in the use of EMDR which is a technique that can help process and resolve trauma.
Therapy Orientation:
My theoretical approach to counseling is a blend of numerous therapeutic approaches including cognitive-behavioral therapy and object relations theory.
Basically this means that I integrate what I have found to be the best and most effective tools and techniques. These are based on scientific research and established standards of practice from various approaches in order to individualize and personalize the most effective interventions possible to your unique and individual needs. I use a multidisciplinary approach when appropriate to facilitate comprehensive care for complex issues. Examples of this may include coordination of care with a family physician, psychiatrist, and school counselor in order to provide additional support and resources for you. I am a
1 Initials_________

Piper Warwick, MS,LMHC
PO Box 1145 Pullman WA 99163
509-270-5460
Christian and if you specifically request I will incorporate Biblical principals into our work together.
Our practice is not designed to provide a 24-hour support system. This means we do not carry pagers and cannot be reached directly during nonbusiness hours. We will, however, check voice mail every other day unless out of cell range or on vacation. If you feel like you have an imminent emergency please contact 911 , call the crisis line at 838-4428 or go to your local hospital emergency room. If you feel that your issues are those such as thoughts of suicide or self-injury, homicide, or other such intense issues that you will require immediate assistance and crisis management, you will need to seek counseling from a local agency that is equipped to provide the level of care that you need.
Confidentiality:
Confidentiality is one of the most important components of the counseling process. It means that what we talk about during sessions is treated as private and stays between us. Confidentiality allows you to feel safe and secure when you share your most intimate of thoughts and feelings. There are, however, limits to confidentiality and circumstances that we are required by Washington State
Law (RCW 18.19.18) to report to appropriate authorities. The following are the limits of our confidentiality:


Any known or suspected child abuse (including physical abuse, sexual abuse, and/or neglect) or any known or suspected abuse of a developmentally disabled person or dependent adult;
Disclosure of imminent intent to commit suicide or engage in self- harm, and disclosure of imminent intent to hurt or kill another person;




In response to a subpoena;
With the written authorization of the client or in the case of death or disability, the person’s legal representative;
If you waive your privilege by bringing charges against this licensed therapist;
Or if we believe disclosure will avoid or minimize an imminent and immediate danger to the health or safety of you or another person.
Your Rights:
Counseling is an important decision and should be a voluntary commitment. This is your personal choice and you have the right and responsibility to receive treatment that is both professional and ethical. You have the right to be treated with respect and dignity. Likewise, you have the right to refuse treatment and choose a counselor whose treatment modality (style) best matches your needs. This, however, does not mean a client has any new rights and is not intended to supersede state or federal laws, regulations, or professional treatment/ ethical standards.
In accordance with WAC 246-810031, “Counselors practicing counseling for a fee must be registered or certified with the department of health for the protection of the public health and safety. Registration of an individual with the
2 Initials_________

Piper Warwick, MS,LMHC
PO Box 1145 Pullman WA 99163
509-270-5460 department does not include a recognition of any practice standards nor necessarily implies the effectiveness of any treatment.
”
You can obtain a complete list of the acts that constitute unprofessional and unethical conduct under Washington State Law. If you have any concerns about your treatment and complaints you may contact the Department of Health:
Health Professions Quality Assurance
PO BOX 47865
Olympia, WA 98504-7865
(360) 263-4700 FAX: (360) 263-4818
E-mail: hpqa.csc@doh.wa.gov
Side Effects and Other Potential Unpleasantness:
You should know that counseling is not always easy and is typically a difficult process. You may find yourself having to discuss very personal information. You could find these conversations difficult and embarrassing, and you might encounter increased conflict with friends, co-workers, and family members. It is possible that you might become somewhat depressed or increasingly irritable. Counseling is intended to alleviate problems, but sometimes, especially at first, and as you are getting to the root of some issues, you may feel an increase in your level of emotional distress and/or an increase in the severity of your symptoms. We may also ask you to do some things, that might, at first, make you feel awkward and uncomfortable. Sometimes counseling requires trying new ways of doing things. You will always be free to move at your own pace, however. We will challenge you and your old ways of thinking and doing things, but we cannot offer any promise about the results you will experience. Your outcome will depend on many different factors.
Scheduling:
After the initial intake session, scheduling will typically be done at the end of the session. We understand that situations and events occur that require you to change, reschedule, or cancel an existing appointment. To change or cancel a current appointment, or to schedule another session, please call our office at
(509) 270-5460. To cancel an appointment without a penalty fee you must contact us or leave a voice message 24 hours prior to that session. Failure to do so will result in being charged the existing fee for the reserved appointment time period. In simple terms, if you have a session Friday at 12pm you must contact me prior to Thursday at 12pm. 24 hours notice does not include weekends unless your appointment is on a weekend. Hence, to cancel a Monday at 12pm session, without any penalty, you will need to contact me prior to Friday at 12pm.
Fees and Billing Information:
We charge $150 for the initial intake session. All of the following 45-50 minute sessions are billed at a rate of $100 per hour. A therapeutic hour entails
45-50 minutes of direct contact time with 10-15 minutes of paperwork, and reviewing your care and its pertinent information. $50 is charged for a half hour
3 Initials_________

Piper Warwick, MS,LMHC
PO Box 1145 Pullman WA 99163
509-270-5460 session (20-25min of direct contact time). In situations where outreach or a home session occurs, the client may also be billed for mileage/travel expenses as appropriate and within reason. Phone calls that extend longer than 10 minutes may be billed at the usual hourly rate of $100. Payment is expected at time of service. A 1% interest rate per month will be charged on all outstanding balances unless a specific payment plan has been negotiated. All uncollected fees may be submitted to a collection agency after 90 days. It is the financial responsibility of the client/guardian (in the event the client is a minor) to pay all charges incurred for the counseling services rendered. This includes costs that insurance does not cover. In the event of nonpayment the client/guardian will bear all costs of collection, including all reasonable court costs, attorney’s fees, and collection expenses.
Your payment/co-pay is due at every session at the beginning of the session. We accept cash or checks for your payment. Our office charges a $30 fee for any check returned for any reason. You insurance will not pay for any missed sessions: you must pay for those, in full, yourself.
4 Initials_________

Piper Warwick, MS,LMHC
PO Box 1145 Pullman WA 99163
509-270-5460
Consent for Counseling Services
I ________________________________(Client’s name), ____________(date of birth) freely consent to receive counseling services from Piper Warwick, MS,
LMHC. I have read and understand all my rights and responsibilities as a client, the counselor’s clinical orientation, and the limits of confidentiality. I have been given the opportunity to ask questions, and I have been provided with satisfactory answers concerning the aforementioned topics. My signature below indicates my individual capacity to consent to counseling services and that consent is given without any undue influence by others. I have also received a copy of the Washington State brochure on counseling.
In the event the client is a minor, I hereby authorize and direct Piper Warwick,
MS, LMHC to treat_________________________my son/ daughter/ minor under my guardianship. I understand that my signature below constitutes a personal guarantee for payment for all charges incurred for the therapeutic services provided.
Client Signature:____________________________________Date:___________
Parent/ Legal Guardian Signature:______________________Date:___________
Therapist/Witness Signature:__________________________Date:___________
5 Initials_________