Professional Disclosure Statements For Mental Health Professionals


The purpose of a professional disclosure statement is to inform clients about your professional background and the limitations of your professional relationship.  It is sometimes referred to as a document of informed consent.

It is important to note that the state you practice in may dictate what must be included in your statement of disclosure.

The following items are often included:

  • Contact info
  • Your qualifications including training, experience, licensure and certifications
  • Professional associations that you belong to
  • Any limitations on your practice such as being under supervision
  • Services offered
  • Your theoretical foundation and counseling approach
  • Fee structure including broken appointments, collecting debt, and cancellation policy
  • Whether or not you will file insurance / provide documentation for your client to file insurance
  • How you handle emergencies and client needs after business hours
  • Confidentiality and exceptions to confidentiality
  • Client rights and responsibilities
  • The professional code(s) of ethics that you adhere to
  • How to file a complaint against you

Your professional disclosure statement is a living document.  By that I mean that it will grow and change as your experience, training, and practice changes.  It’s a good idea to review (and amend as needed) your disclosure statement at least annually.

When writing your disclosure statement, you may find it helpful to gather samples of other professionals statements.  You will find a copy of my disclosure statement here at my counseling website.

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  1. Michelle Stevens, MA, JD of Introspection Counseling just reminded me that we also need to include permission to consult with other professionals.

    Thanks, Michelle!

  2. Tamara,
    I just found your website and I think I am going to like it. I wish I would have found it 2 years ago when i started my private practice!


    • Hi, Jacqui! Welcome to Private Practice from the Inside Out! How did you find us here?

      We are building a very supportive and resource-rich based online community here and I’m so glad to meet you and add you to the gang! Looking forward to hearing your voice as part of the dialogue concerning building a strong and vibrant private practice!

      Let me know if there is anything I / we can do to support you on your journey!


  1. […] your disclosure statement. You need to make sure that you revise all written documents related to this new policy change […]

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