Psychotherapy
- Couples
In Person Art Therapy
Online Art in Therapy Terms and Conditions
Age: In order to receive Online Art in Therapy from Kristrinah Ayala, you must be 21 years of age or older.
Confidentiality:
I will not sell, give or trade your email or personal information to a third party. This site does not receive any information about your credit card information processed securely through Paypal.
Your email and my responses are the only records kept and, are confidentially maintained on my computer.
Limits of Confidentiality: There are some situations where I am permitted or required to disclose information without either your consent or your written authorization:
-If you are involved in a court proceeding and a request is made for information concerning my professional services, such information is protected by the psychotherapist-client privilege law. I cannot provide any information without your written authorization, or a court order. If you are involved in or contemplating litigation, you should consult with your attorney to determine whether a court would be likely to order me to disclose information.
-If a government agency is requesting the information for health oversight activities, I may be required to provide it for them.
-If a client files a complaint or lawsuit against me, I may disclose relevant information regarding that client in order to defend myself.
-If a client files a worker’s compensation claim, and I am providing treatment related to the claim, I must, upon appropriate request, furnish copies of all medical reports and bills.
I am legally obligated to take actions, which I believe are necessary to attempt to protect others from harm, and I may have to reveal some information about your treatment. These situations are unusual in my practice.
There are some situations in which- If I have reason to believe that a child has been abused, the law requires that I file a report with the appropriate governmental agency, usually the Department of Human Resources. Once such a report is filed, I may be required to provide additional information.
- If I have reasonable cause to believe that a disabled adult or elder person has had a physical injury or injuries inflicted upon such disabled adult or elder person, other than by accidental means, or has been neglected or exploited, I must report to an agency designated by the Department of Human Resources. Once such a report is filed, I may be required to provide additional information.
Your Signature below indicates that you have read my entire Terms and Conditions and agree to all of its terms.-If I determine that a client presents a serious danger of violence to another, I may be required to take protective actions. These actions may include notifying the potential victim, and/or contacting the police, and/or seeking hospitalization for the client. If such a situation arises, I will make every effort to fully discuss it with you before taking any action and I will limit my disclosure to what is necessary.
Printed Name:____________________________________________________________________
Signature:_______________________________________________________________________
Date:___________________________________________________________________________
Please Scan this page and attach it with your email.
If you are in Crisis:
Online art in therapy is not designed for people in crisis. If you are in crisis, call 911 or go to your nearest Emergency Room