Client’s Rights/Informed Consent for Peer Support

 

I understand that peer support offered by Hope Thrives is spiritual/prayer ministry and not counseling or therapy sessions. Hope Thrives NPO, Inc. does not keep detailed records and will not provide information for lawyers, or disability claims, or for similar matters. I further understand that my personal files are protected as “CONFIDENTIAL.” As such, identifying, specific details of my file may not be disclosed to others without my written consent except as specified by Georgia law:

  1. As required by subpoena or court order in legal proceedings.

  2. When not to do so would potentially result in physical harm to myself or others.

  3. To report any disclosure/suspicion of child/elderly abuse (physical, mental, or sexual).

I also understand that this ministry uses services of trained peer specialists and ministers, not licensed counselors.  I agree to hold Hope Thrives NPO, Inc., its officers, employees, contractors and peer support specialists free from any and all liability, loss, or damage of any kind that may arise as a result of assistance that I have received from my involvement with Hope Thrives.

I also understand there is a process for dealing with any potential sexual advances or harassment while participating in peer support sessions. If at any time I feel offended by anything my specialist asks, says, or does, I acknowledge it is my responsibility to tell him or her. If the behavior does not stop immediately, and if the circumstances of the offensive words/actions are such that I am uncomfortable confronting the specialist, I also acknowledge it is my responsibility to report it immediately in writing to Mike Franklin, CEO, 800 Cannon Bridge Road, Demorest, GA 30535.

I also understand extenuating circumstances arise from time to time. On such occasions the specialist may need to cancel and reschedule an appointment. All effort will be made to give me 24 hours notification of a necessary change. In the event the specialist must cancel without advanced notice, I agree to reschedule my appointment. I also agree to give the specialist 24 hours notice if I need to cancel or change an appointment, unless extenuating circumstances prevent me from doing so. In that situation, I will call and reschedule as soon as I am able.