Confidentiality
You can feel more comfortable sharing private information in the counseling process knowing that your counselor is legally and ethically required to maintain your confidentiality. The following statement describes both the importance Dina places on confidentiality as well as its necessary limits. She will ask you to read and sign a Privacy Practices Acknowledgement at the beginning of your work together. She is glad to discuss any questions or concerns you may have about this issue. Click here to print and sign this form prior to your first session.

Privacy Practices | Case Consultation | Legal Exceptions

Privacy Practices

With the exception of certain specific circumstances described below, you have the absolute right to the confidentiality of your therapy. Dina cannot and will not tell anyone else what you have told her, or even that you are in therapy with her, without your prior written permission. She will always act so as to protect your privacy to the fullest extent possible even if you have authorized her in writing to share information about you. You may direct her to share information with whomever you choose, and you can change your mind and revoke that permission in writing at any time. If you revoke permission, it will prevent any disclosures after the date received but cannot change the fact that some information may have been sent or shared before that date.

Case Consultation & Confidentiality

Acting responsibly as a therapist requires Dina on occasion to consult professionally with other therapists in order to provide the best possible treatment. This consultation is done in such a way that protects the anonymity of her clients and that they remain unidentifiable. If you inform her that there is a particular person with whom you would not want even this anonymous consultation to occur, she will respect your wishes.

Legal Exceptions to Confidentiality

The following are key legal exceptions to your right to confidentiality (for a full description, see Notice of Privacy Practices). She will inform you, in advance if possible, should she need to put any of these exceptions into effect:
  • If Dina has good reason to believe that you are in imminent danger of harming yourself, she may legally break confidentiality and call the police or other medical emergency services. If possible, she will make every effort to explore all other options with you to help keep you safe, before she takes this step.
  • If she has good reason to believe that you are abusing or neglecting a child or vulnerable adult, or if you give her information about someone else who is doing so, she must inform the appropriate authorities. She will make every effort to discuss the situation with you prior to taking action.
  • If she has good reason to believe that you will harm another person, she must attempt to inform that person, and warn them of your intentions. She must also contact the police and ask them to protect your intended victim.
  • If you are filing a complaint or are a plaintiff in a lawsuit, it is possible that her testimony or your file may be subpoenaed as evidence. To the extent possible, she will do her utmost to protect your privacy in this circumstance.
  • If you are party to a court-ordered parent coordination agreement, the parenting coordinator has full legal authority to request information regarding your treatment. To the extent possible, she will do her utmost to protect your privacy by limiting unnecessary disclosure about your treatment.
Please review the Privacy Practices Acknowledgement to print and sign this form prior to your first session.