SoulFully Urs, LLC
EXPECTATIONS, RIGHTS AND RESPONSIBILITIES
Welcome to SOULFULLY URS, LLC, this information is meant to help you understand what you can
expect while in therapy. We encourage you to read it carefully and discuss any concerns you
have with your therapist.
The therapeutic relationship is confidential, which means your therapist(s) will not give out any
information about you without your written consent. State law and ethical standards of
psychology require that we report information about you in the following circumstances:
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If there is a clear and imminent danger that you may harm yourself or others
If a record is court-ordered by a proper legal authority
If there is suspected or confirmed abuse of children or vulnerable adults
If you are a minor and are not considered emancipated (living away from home and/or
supporting yourself)
If you describe sexual exploitation by a previous therapist
If you are pregnant and using a felonious drug (e.g., cocaine, heroin)
I: EXPECTATIONS
The Counseling staff are professionals with differing areas of expertise, and includes those who
work under the direct supervision of licensed clinical social workers. To provide you with the best
service, your therapist(s) may discuss your situation with another social worker, psychiatrist or
counselor who is directly involved in providing clinical services. If you receive mental health
services at another agency, we may request to share your records with them to ensure
continuity of care. All information shared among these professionals is considered confidential.
Records are maintained on a confidential electronic records system. You may see all records
about yourself if you wish. However, it is seldom beneficial during the therapy process.
It is your right to know the goals and treatment plan for therapy as well as your therapists’ views
on your presenting issues. This includes the expected length of treatment. In the first few sessions
your therapists will work with you to clarify goals and establish a treatment plan for your work
together. Periodically you will review your progress as well as your satisfaction with your work
together. The determination to make a change requires a commitment from you. Often
change is a slow and painful process. It’s tempting to quit when things get intense, but we
encourage you to stick with it through these difficult times. If you do not return for therapy, we
will automatically close your case after three (3) months. However, you are welcome to return
at any time.
It is your right to know the educational and experiential background of your therapists. The
Counseling staff is composed of individuals who are licensed social workers in the state of Texas.
We also have qualified masters’ interns and practicum students completing master’s or
bachelor’s degrees in counseling or clinical social work. All interns and practicum students
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receive individual supervision on a weekly basis from a licensed clinical social worker. Practicum
students also receive individual supervision from a licensed masters’ social worker.
Depending on the presenting concerns, people respond better to various kinds of help. These
include group therapy, individual therapy, family therapy, support groups for people with
specific problems, twelve-step programs such as Alcoholics Anonymous and Emotions
Anonymous, peer counseling, community education courses such as assertiveness training and
stress management, and centers and clinics that specialize in issues such as eating disorders or
sexual assault. Your therapists may refer you to some of these resources and it is your right to ask
for specific referrals.
Psychological testing may be recommended in some cases. The cost of testing is based on
processing costs. You will be informed of any fees before you commit to taking an assessment.
Therapy sessions vary in length, from 60-90 minutes for groups, and from 30-50 minutes for
individual. If for any reason you are late, the session will have to end at the regular time. If you
must cancel an appointment, please do so as soon as possible so that your time may be
available for others. Notify the front desk staff at 281-305-3014, and they will help you reschedule.
If you no-show or cancel with less than 24-hour notice for three appointments per year you will
be charged a fee for services or services may be terminated. Referrals will be provided if
needed.
Your therapist(s) may ask you to do some special reading, thinking, or some other task outside of
sessions to help you attain your goals more quickly. We know that time is precious to students,
but we believe that time spent in personal growth is equally important.
We are committed to providing ethical, respectful and competent psychological services
regardless of race, religion, ethnic background, gender, sexual orientation, sexual identify, or
disability. You can expect that we will provide high quality professional service.
If for any reason you are dissatisfied with the service you are receiving, please discuss this with
your therapist(s). If you are uncomfortable speaking directly to your therapist(s), you may make
an appointment with Teresa Fuller, LCSW, LCDC, CEO, Director of Counseling and Psychological
Services, to discuss your concerns.
Crisis situations do occur from time to time. You may contact your therapist(s) at SOULFULLY URS,
LLC, or the Crisis Intervention of Houston @ (832) 416-1177. If no one is available, we encourage
you to contact one of the following crisis centers:
Emergency Dispatch: 911
National Suicide Prevention Hotline (24 hour): (800) 273-TALK (8255)
The Harris Center Crisis Line (24 hour): (713) 970-7000
Houston Area Women’s Ctr. Sex. Assault Hotline (24 hour): (713) 528-RAPE (7273) www.hawc.org
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Houston Police Dept. Adult Sex Crimes Unit: (713) 308-1180
The following is a copy of the Rights and Responsibilities that clients will sign when they begin
services at SOULFULLY URS, LLC. Please read the following information carefully and feel free to
ask any questions.
II: RIGHTS
***If you have any questions or concerns about these rights and responsibilities, please discuss
them with your therapist(s).
Eligibility: Services are open to any and everyone. (we have the right to refuse service to
anyone).
Services: During the Initial appointment, you will meet with a counselor to discuss counseling
options that may include individual, group, couples counseling, or a community referral.
Confidentiality: It is the policy of that all information discussed with a counselor is confidential.
Written, telephone, or personal inquiries about you will not be acknowledged. No information
about you can be released to anyone other than you without your written permission. An
exception to this policy may arise in situations of child abuse or neglect; abuse or neglect of a
vulnerable adult (an elder adult or a physically or mentally impaired adult); or where there is a
clear and immediate danger to yourself or others. Please discuss any questions with your
counselor.
Email is not a secure medium so any correspondence you may have with SOULFULLY URS, LLC or
your counselor via email cannot be guaranteed to remain confidential.
Respect: The counselor and SOULFULLY URS, LLC respects you and will convey this respect by
keeping appointments or contacting you to reschedule if necessary, giving you complete
attention during sessions, minimizing interruptions during session, and providing quality counseling.
You have the right to receive professional services within your personal belief and value system.
You also have the right to participate in developing your individual treatment plan or to request
alternative treatment.
III: RESPONSIBILITIES
Initial Visit: Once you are assigned to a counselor, SOULFULLY URS staff will make three (3)
attempts to contact you to arrange an initial appointment. After the third attempt to contact
you, without hearing back from you, a letter will be sent to you requesting that you contact us
within 1-week (7) days. If we do not hear back from you within 1-week (7) days, your file will be
closed.
Participation & Appointments: Your active participation in therapy is necessary in order to make
progress. Appointments generally take place every 12-14 days. Appointments last 40-45 minutes.
Arriving on time will allow you to take full advantage of your session. If you are more than 15
minutes late to your appointment, you will need to reschedule.
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*Please turn off cell phones during appointments.
Taping: We may tape client sessions at SOULFULLY URS. This is done primarily to facilitate the
supervision of clinicians in training and secondarily as a way for staff to consult with one another.
Only professional SOULFULLY URS personnel are permitted to view taped sessions.
Fees: We do not turn away clients for an inability to pay. We accept insurance as well as self pay
for services. Sessions are $100 per session, if paid for individually/weekly; discounts are available
to those who prepay for sessions. We also offer a sliding fee program for our lower income clients.
Please be aware that a $25.00 fee will be charged for a missed Initial appointment, your file will
be closed and this fee must be paid before scheduling another appointment. A $25.00 fee will
be charged for missed counseling sessions and group appointments A $25 00 PER HOUR fee will
be applied for missed counseling sessions and group appointments. A $25.00, PER HOUR fee, will
be charged for a missed Assessment appointment. A missed appointment occurs when a client
No-shows, cancels or reschedules, with less than 24 hours’ notice or arrives 15 minutes late for an
appointment. After 3 No-shows, cancellations, or rescheduling your file will be closed, and may
result in limited access to our services, including group and biofeedback, and may be grounds
for discontinuing treatment at SOULFULLY URS. In the event of a fee, a hold will be placed on
your account,
Fees can be paid on our website and/or through other methods such as Zelle, CashApp and
PayPal. No-show policy: If you miss a regular appointment without calling in advance, you are
responsible to either reschedule or to inform SOULFULLY URS, LLC that you are no longer
interested in services. If you do not contact SOULFULLY URS within 30 days of your last attended
appointment, your file will be closed. If you No-show your first Initial appointment, we will
understand that you are no longer interested in services and your file will be closed. You are
welcome to reinitiate services at any time.
Feedback/Change of Counselor: SOULFULLY URS is interested in your feedback. If you are not
satisfied with your counseling, experience or would like to be assigned a new counselor, please
discuss this first with your current assigned counselor.
Urgent Consultation Services: Urgent services are to address acute mental health needs, these
needs included: Suicidal ideation, intent to take your life, intent to harm or take someone else’s
life, inability to keep yourself safe, a recently experienced assault, sexual or otherwise, you are
experiencing hallucinations or psychotic symptoms, or you believe that your life is in danger. If
you need urgent services SOULFULLY URS, LLC business hours (M-Th 11:00 AM to 8:00 PM and F
11:00 AM to 4:00 PM) you are encouraged to speak to the front desk (281) 758-8484 and arrange
an urgent consultation. If SOULFULLY URS is not open, please call 911, or go to the nearest
emergency room. If you are outside of Harris County, we ask that you seek immediate services
from your local law enforcement or go to the nearest hospital.
Other:
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Court Ordered Treatment: SOULFULLY URS, LLC does assess, write letters or make
recommendations to a court on a case-by-case basis. This includes but is not limited to anger
management, drug and alcohol assessment, etc. If Soulfully Urs does not have the resources or
ability to accommodate these needs the courts are also able to provide community resources
to accomplish these requirements.
Release of Records: Records will ONLY be released to individual providers or government
agencies, SOULFULLY URS, LLC does not release records to individuals. Once a Release of
Records is signed it will take up to 12 weeks to gather and release records.
Support Animals: In accordance with APA guidelines and best practice models SOULFULLY URS,
LLC is able to assess, write letters or make recommendations for emotional support animals.
Ethical Practices:
Counselor’s/therapist’s adhere to professional ethical principles. Ethical standards are designed
to serve the best interests of the clients. These standards govern topics such as professional
practices, counselor-client relationships, the provision of services and the use of assessment and
evaluation in counseling.
Your counselor will discuss his or her qualifications, training and areas of expertise.
You can expect that your counselor will provide information about the counseling services and
fees, including the purposes, goals and benefits of the counseling services that you will receive.
Your counselor will discuss with you guidelines regarding confidentiality, privacy and disclosure of
information for the counseling process.
Find out to which professional association guidelines your prospective career professional
adheres. Review those ethical standards of the professional with whom you are considering
working. You may find the guidelines on the web or ask the counselor for a copy. The following
professional organizations provide information regarding their respective ethical codes and
standards:
National Association of Social Workers https://www.naswtx.org
American Psychological Association http://www.apa.org
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CLIENT RIGHTS & RESPONSIBILITIES
SoulFully Urs, LLC
The following is a list of some of the many rights you have as our client. You cannot be denied,
suspended or discharged from services for exercising your rights.
Translation services are currently not available. SOULFULLY URS, LLC complies with applicable
Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age,
disability, or sex. Human Rights You have rights, bene
As a client receiving behavioral health services at SOULFULLY URS, LLC, you have the right to:
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Be treated with dignity and respect from all staff.
Access treatment regardless of race, color, religion, national origin, age, sex, sexual
orientation, gender identity, marital status, familial status, disability, veteran status, or any
other legally protected group status.
Every consideration of privacy concerning your care as outlined in our Privacy Practices.
Information regarding diagnosis and treatment provided in terms that are easily
understood.
Ask questions and get appropriate answers about services.
Participate fully in all decisions about treatment or services, which includes informed
consent to all services. In the event the client is unable to give informed consent, a
legally responsible party has the right to be advised regarding treatment
recommendations.
Understand your financial obligations for treatment.
Request changes in treatment or services. This includes the right to a new intake with
another clinician should you feel a second opinion is needed or you desire another
clinician.
Refuse assessment and/or treatment unless ordered by the Court to participate.
Participate fully in decisions regarding your discharge from treatment including planning
for continued care if needed.
Have your family involved in your treatment as well as refuse participation if you choose.
Request to review your records as well as decide who else may do so with appropriate
prior written authorization.
Receive humane care and treatment, with respect and consideration privacy and
confidentiality when seeking or receiving care except for life threatening situations or
conditions confidentiality of your health records receive accurate information
concerning diagnosis, treatment, risks, and prognosis of an illness or health condition ask
about reasonable alternatives to care at SoulFully Urs, LLC or outside facilities
A second professional opinion regarding diagnosis or treatment
Participate actively in decisions regarding one’s healthcare and treatment accessible
information regarding the scope and availability of services
Be informed about any legal reporting requirements regarding any aspect of screening
or treatment
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SoulFully Urs, LLC
Receive a copy of your medical record upon request and written authorization
File a complaint with the director of HCS regarding any concerns related to the privacy,
confidentiality or security of your medical record
Review and amend your medical record
Revoke your authorization to release except to the extent that action has not already
been taken
Receive a copy of any fees and charges related to your visit
Be informed of the qualifications of your therapist/counselor: education, experience,
professional counseling certifications, and license(s).
Receive an explanation of services offered, your time commitments, fee scales, and
billing policies prior to receipt of services.
Be informed of the limitations of the therapist/counselor's practice to special areas of
expertise (career development, ethnic groups, etc) or age group (adolescents, older
adults, etc.). Have all that you say treated confidentially and be informed of any state
laws placing limitations on confidentiality in the counseling relationship.
Ask questions about the counseling techniques and strategies and be informed of your
progress.
Participate in setting goals and evaluating progress toward meeting them.
Be informed of how to contact the counselor in an emergency situation.
Request copies of records and reports to be used by other counseling professionals.
Receive a copy of the code of ethics to which your counselor adheres.
Contact the appropriate professional organization if you have doubts or complaints
relative to the counselor's conduct.
Terminate the relationship at any time.
It is our expectation that you will assume responsibility for the following:
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Participate in your treatment in a cooperative and respectful manner. Clinicians reserve
the right to terminate therapy due to the patient's failure to comply with treatment
recommendations and/or failed appointments.
Be courteous to other clients and staff.
Respect the property of the SOULFULLY URS, LLC, including the parking lot, waiting area,
restrooms, and any assessment or treatment materials utilized during your services.
Maintain financial responsibility for all payment of services. This includes following noshow and cancellation policies set forth by the SOULFULLY URS, LLC as well as fees for
other services as outlined in our informed consent.
Protect your belongings. SOULFULLY URS, LLC is not responsible for any lost or stolen client
belongings (in-office clients).
Arrange for transportation to and from services (in-office clients).
Communicate with our staff. Staff are committed to best practice. You are responsible to
let our staff know if you have any questions or problems.
Refrain from utilizing alcohol or drugs prior to or during assessment or treatment sessions or
engaging in an illegal activity while on the premises. Soulfully Urs, LLC reserves the right to
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contact authorities if a client presents in a manner that poses a concern for safety to our
staff and/or other clients.
Provide complete information about one’s illness/problem, to enable proper evaluation
and treatment
Ask questions to ensure an understanding of the condition or problem
Show respect to health personnel and other patients
Reschedule/cancel an appointment so another person may see a physician
Pay bills or file health claims in a timely manner
Use prescription or medical devices for oneself only
Inform the practitioner(s) if one’s condition worsens or an unexpected reaction occurs
from a medication
Provide requests for permission to release health records in writing to SOULFULLY URS, LLC
Set and keep appointments with your counselor. Let him or her know as soon as possible
if you cannot keep an appointment.
Pay your fees in accordance with the schedule you pre-established with the counselor.
Help plan your goals.
Follow through with agreed upon goals.
Keep your counselor informed of your progress towards meeting your goals.
Terminate your counseling relationship before entering into arrangements with another
counselor.
If you are Dissatisfied with the Services of a Counselor:
Remember that a counselor who meets the needs of one person may be wrong for another. If
you are dissatisfied with the services of your counselor:
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Express your concern directly to the counselor, if possible.
Seek the advice of the counselor's supervisor if the counselor is practicing in a setting
where he or she receives direct supervision.
Terminate the counseling relationship, if the situation remains unresolved.
Contact the appropriate state licensing board, national certification organization, or
professional association, if you believe the counselor's conduct to be unethical.
I certify that I have reviewed with consumer as well as provided a copy of client expectations,
rights and responsibilities to the consumer.
Print name____________________________
Signature _____________________________
Date _______________________________
By signing below, I certify that I have read and received a copy of client expectations, rights
and responsibilities.
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Print name ___________________________
Signature ____________________________
Date ________________________________
THERAPY PROCESS [#T.F. 61810]
YOUR THERAPIST [#T.F. 61810]
GRIEVANCE [#T.F. 61810]
CRISIS REFERRAL INFORMATION [#T.F. 61810]
ALTERNATIVE TREATMENTS [#T.F.61810]
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