Recipient Rights & Authorization to Treat
Clients of Last Frontier Counseling voluntarily consent to treatment, and agree to an established set of Rights and Responsibilities. Please carefully read the following statements and indicate your consent below.  Last Frontier Counseling does not discriminate on the basis of race, color, national origin, religion, sex, disability, age, relationship status, or sexual orientation.
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Client Rights
You have the right to be treated with dignity and respect.

You have a right to be involved in your treatment plan and it will be done with your understanding and approval.

You have a right to end your involvement in the program at any time.

You have a right to know the cost to you for services provided.

You have the right to know if you, or information about you, will be used in any way.

You have a right to know when violation of program rules could lead to your discharge.

Information about you and your treatment is confidential. Information will be released only if:
a) You or your legal guardian gives permission in writing.
b) It is necessary to keep you and others from being physically harmed.
c) There is reason to believe or suspect that abuse or neglect of a child or vulnerable adult has occurred.

Client Responsibilities
You are responsible to attend scheduled appointments or cancel in a timely manner. Failure to give notice for or attend three (3) consecutive appointments may result in discharge from services.

You are responsible to pay the agreed upon fee for each session. Payment is due upon receipt of services. You are responsible for all charges.

You are responsible for informing your therapist of any change in your address and/or telephone number.

You are responsible to be actively involved in the planning of your treatment goals and work to achieve those goals.

You are responsible for respecting the rights, privacy, property and beliefs of others by showing courtesy and
consideration to both staff and fellow recipients.

In the event you do not maintain these responsibilities, services will be terminated.

Last Frontier Counseling reserves the right to terminate services for the following reasons:
a) Client becomes violent, threatens violence, or becomes verbally abusive or inappropriate towards staff.
b) Client shows disrespect to staff.
c) Your counselor determines that services can be better provided elsewhere.
d) There has been no contact with the person served for 30 days and there were no prior arrangements made for this lapse.
Grievance Procedure
If you feel a right has been violated, you have the right to file a complaint in writing, regarding service provision to Last Frontier Counseling without fear of retaliation or denial of service.

You're entitled to all civil rights guaranteed by state and federal law.

You have a right to access some contents of your clinical records.

You have a right to be notified if any violation of program rules could lead to a discontinuation of service provision.
I have read my Rights and Responsibilities as a client of Last Frontier Counseling, and consent to follow these standards. *
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