Shopping Cart
Your Cart is Empty
There was an error with PayPalClick here to try again
CelebrateThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart

Professional Christian Counseling

                Emotionally Focused...Solution Driven Counseling

  Bulding Healthy Marriages and Strong Families

Counselworx™ Policy

How it Works

Consent for Services: Counselworx™ operations are based within the State of Indiana and must therefore adhere to Indiana Sate Laws that govern counseling practices and services. Indiana requires that mental health providers obtain a signed consent for services prior to providing any such services. A parent or legal guardian must grant permission in order that any persons under the age of eighteen may receive counseling services.

Confirmation: I confirm that I am the legal, custodial parent or guardian of the minor child/teen under age eighteen named below. I give my permission for the psychological assessment and/or treatment by a Counselworx™ Counselor of this child. I understand that this permission will remain in effect during the duration of my child/teen's services with Counselworx™ or until revoked by me in writing.

Parental Confirmation and Consent to Counseling

Acceptance of Counselworx Policies*
This site uses Google reCAPTCHA technology to fight spam. Your use of reCAPTCHA is subject to Google's Privacy Policy and Terms of Service.

Thank you for confirming your parental status and for granting permission for Counselworx™ to counsel with your child.

Need to Share Your Child's Progress with Others?

Release of Child Information

Downloadable Version of Parental Consent