Consent & Confidentiality Form

Consent & Confidentiality Form

Life Coaching/Therapy/Counseling

Confidentiality means that Myriam Rosas has a responsibility to safeguard information obtained during counseling, life coaching, and therapy. All identifying information about your assessment and/or treatment is kept confidential, except only what is mandated by law.

I understand that Myriam Rosas is a member of the APA and follows the ethical principles and code of conduct of the American Psychological Association.

I understand that Myriam Rosas works independently from any religious or mental organization. I trust in her abilities, ethics, and knowledge to train and advise me.

I understand that Myriam Rosas works ethically and will not share any confidential information about any of her clients. For this reason, I respect her prudence when it comes to the confidentiality of other people.

I release Myriam Rosas from any liability, and/or any future claims that may harm her due to my personal problem and/or situation.

I understand she does not receive any extra compensation besides her established service fees.

I understand that I receive life coaching, counseling, and Christian training for the purpose of my personal healing, emotional stability, growth, and discovery of new goals.

I agree with this statement.