INFORMED CONSENT FOR COUNSELING, THERAPY, COACHING & PASTORAL COUNSELING
Client Rights • Confidentiality • Appointments • Financial Responsibility • Cancellation • Refunds • Program Policies
Shawn McBride, MA, LCPC | The Couples Counseling & Coaching Center, LLC | Shawn McBride Therapy, LLC
Maryland: LCPC15835 • South Carolina: 12149 • Florida: MH28699 • Arizona: LPC-25028
Federal Tax ID: 86-2615979
1. Practice and service categories
Shawn McBride is the sole licensed clinician providing psychotherapy through this practice. Services may include individual and couples therapy, premarital counseling, relationship intensives, structured programs, and assessments. The type of service and provider will be identified before services begin.
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Clinical therapy: licensed mental health assessment and treatment, provided only where the clinician is authorized to practice.
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Pastoral counseling: faith-based spiritual guidance; not a substitute for mental health treatment unless expressly provided as licensed clinical care.
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Coaching: nonclinical relationship education, personal development, and accountability; does not diagnose or treat mental health conditions.
Other team members, facilitators, coaches, pastoral counselors, or staff do not provide psychotherapy under this practice unless licensed.
The identity, credentials, scope, privacy expectations, and fee terms of any other service provider should be separately disclosed. A coaching or pastoral label does not override applicable licensing law.
2. Nature, benefits, risks, and limits of services
Services are collaborative and may involve examining difficult experiences, emotional discomfort, temporary increases in conflict, and changes in relationships. Potential benefits include greater insight, coping skills, and improved communication. Results and relationship outcomes cannot be guaranteed. Clients may ask questions or decline particular interventions. Referrals to outside clinicians or psychologists may be appropriate for services outside this practice’s scope, including formal psychological evaluations or inpatient care.
3. Client rights and responsibilities
Clients are entitled to competent, respectful, ethical care; information about the proposed approach; participation in treatment decisions; privacy protections; access to records as provided by law; and an opportunity to raise concerns or request referrals. Clients may discontinue treatment at any time. Financial responsibility, if any, is determined by applicable law and a separately disclosed service or program agreement; discontinuing care does not waive statutory rights. Clients are expected to provide accurate information, participate in scheduling, and follow mutually agreed safety and communication plans.
4. Appointments, lateness, and cancellations
Standard appointments generally last 55 minutes; intensives and program sessions may be longer. Appointments may be weekly,
biweekly, or program-based. At least 24 hours’ notice is required to cancel or reschedule an appointment. A late cancellation or missed appointment may incur the full disclosed session fee, subject to applicable law and any agreed exceptions. Arrival more than 15 minutes late may be treated as a missed appointment; contact the practice as soon as possible. The practice may waive a charge in its discretion. No charge will be imposed where prohibited by law.
5. Confidentiality and legally required disclosures
Clinical records and protected health information are handled under applicable privacy and professional laws. Confidentiality has exceptions, including mandated reporting of suspected abuse or neglect, serious safety risks, lawful court orders, and other legally authorized or required disclosures. Clients may request information about records access, amendments, and privacy restrictions. The practice’s Notice of Privacy Practices, where applicable, provides additional details. Privacy standards for nonclinical coaching and pastoral services may differ and should be explained before enrollment.
6. Couples and family treatment: no-secrets framework
In couples or family therapy, the treatment unit and confidentiality boundaries will be discussed at intake. The practice uses a no-secrets framework: information shared individually that is materially relevant to joint treatment may need to be addressed within the treatment unit. This does not authorize unrestricted disclosure, and any disclosure remains subject to law, professional duties, safety considerations, and informed consent. Clients should ask how individual communications, records requests, and separate sessions will be handled before sharing sensitive information.
7. Telehealth, emergencies, and communications
Virtual services may be available when legally authorized at the client’s physical location. Clients should use a private setting and disclose their physical location at each telehealth visit when requested. Technology carries risks of interruption or unauthorized access; a backup contact plan may be used. This practice is not an emergency or crisis service. For immediate danger, call 911 or local emergency services; in the United States, call or text 988 for crisis support.
Text, email, voicemail, and social media are for scheduling and administrative communications, not psychotherapy or emergency care. Voicemail is ordinarily returned within 24 hours excluding weekends, but this is not a guarantee. Do not send urgent clinical concerns by these channels. Electronic messages may carry privacy risks.
8. Fees, payment, and financing
Session fees, intensive fees, package prices, payment schedules, and any changes will be disclosed before the relevant service or enrollment. Payment is due as stated in the applicable agreement. Accepted payment methods may include credit cards and approved third-party financing. Financing arrangements are separately governed by the lender’s terms. No insurance acceptance or reimbursement is guaranteed; superbills, when offered, do not guarantee payment by an insurer. Fees will not be increased retroactively for completed services.
CareCredit financing
When permitted by applicable law and the CareCredit merchant agreement, clients who elect to pay through CareCredit will be charged an additional financing-related fee equal to 25.05% of the standard service price. CareCredit deducts merchant financing fees from payments made to the practice; this additional charge is intended to offset those costs. The full financed price, including any additional fee, will be clearly disclosed before the client authorizes payment. Clients may choose another accepted payment method without this CareCredit-specific additional charge. No such fee will be assessed where prohibited by law or the CareCredit merchant agreement.
Example: A three-hour intensive priced at $1,497 has a proposed additional CareCredit charge of $375, resulting in a total financed price of $1,872. The 25.05% figure is rounded; the actual charge for this example is $375.
9. Packages, programs, and reserved capacity
Programs and multi-session packages may include clinical time, planning, assessments, reserved appointment capacity, educational materials, and other defined components. A separate written enrollment agreement should state the duration, deliverables, total price, allocation of fees, payment schedule, expiration, cancellation rights, and treatment of unused sessions. Enrollment may reserve clinical or administrative capacity, but the treatment of prepaid, unearned, or unused amounts is governed by applicable law and the signed agreement. Participation and outcomes are not guaranteed.
10. Refunds, missed sessions, and early discontinuation
Fees for completed services and work already performed generally are not refundable, except as required by law or expressly agreed in writing. Late-cancellation and missed-appointment fees apply only as disclosed and permitted by law. Refunds or credits for unused prepaid services, unearned fees, canceled services, or early termination will be calculated under applicable law and the specific program agreement. A client may stop therapy at any time; doing so does not automatically mean every unpaid future session becomes due. Dissatisfaction with an outcome alone does not establish a refund entitlement for services already provided, but does not waive legal rights.
11. Assessments, reports, and professional review
Assessments, scoring, reports, evaluations, and professional reviews involve dedicated professional time. The Comprehensive Couples Assessment fee is $330, subject to confirmation in the applicable service agreement. Fees attributable to assessment work already performed may be non-refundable to the extent lawful. Any deduction from a refund will reflect actual authorized work and the applicable agreement. Assessment preparation time varies according to the nature and complexity of the assessment.
12. Clinical documentation and work outside sessions
Necessary clinical documentation is part of professional care. Additional requested reports, extensive records review, consultation, and other separately billable professional services may be charged at a disclosed rate only where lawful and agreed in advance. Routine clinical documentation and legally required record access will not automatically incur a separate therapy-hour charge. The practice will disclose any applicable fee schedule and obtain authorization where required.
13. Termination, Referrals, Non-Refundable Programs, and Transferability
All services, programs, packages, and intensives offered by The Couples Counseling & Coaching Center, LLC are non-refundable, except when services are terminated or canceled by the practice or when a refund is otherwise required by applicable law.
Full payment is required at the time of booking or enrollment unless an alternative payment arrangement has been expressly approved in writing.
Clients understand and acknowledge that enrolling in a counseling or therapy program represents a financial commitment to the entire program, not merely the individual sessions attended. Program fees reflect the reservation of professional time, clinical availability, treatment planning, assessments, administrative resources, and the structured services associated with the program.
Client-Initiated Termination: Clients retain the right to discontinue counseling or therapy at any time. However, voluntarily withdrawing from a program before its scheduled completion does not automatically entitle the client to a refund, partial refund, credit, or cancellation of outstanding contractual payment obligations, subject to applicable law.
For example, a client who enrolls in a seven-month, 14-session counseling program and elects to discontinue after completing 10 sessions because of separation, divorce, reconciliation, dissatisfaction, or another personal circumstance is not automatically entitled to reimbursement for the remaining four sessions.
Clients acknowledge that counseling and therapy are professional services, not guarantees of specific personal or relationship outcomes. A decision to separate, divorce, reconcile, or terminate a relationship does not, by itself, constitute a failure by the practice to provide the agreed-upon professional services.
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Practice-Initiated Termination: If The Couples Counseling & Coaching Center terminates or cancels services, the practice will review any prepaid, unprovided services and issue refunds or credits as required by applicable law and the governing service agreement. When clinically appropriate, reasonable efforts will be made to provide referrals or transition assistance to avoid client abandonment.
Transferability: Unused sessions, program benefits, and service packages are non-transferable to another individual, couple, or program without prior written authorization from the practice, except where otherwise required by law.
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14. Payment Disputes, Chargebacks, and Financial Responsibility
All clients acknowledge and agree to the financial terms, cancellation requirements, and refund provisions of The Couples Counseling & Coaching Center, LLC before scheduling services, enrolling in a program, or authorizing payment.
Full payment for services is required upon booking or enrollment unless a separate written payment arrangement has been approved.
By enrolling in a counseling or therapy program, clients acknowledge that they are purchasing a defined professional service package that may include reserved appointments, treatment planning, clinical assessments, preparation, and other agreed-upon program components.
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Clients further acknowledge and understand the following:
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No Guaranteed Outcomes: The practice does not guarantee reconciliation, prevention of divorce, restoration of trust, improved intimacy, or any other specific therapeutic or relationship outcome.
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Voluntary Discontinuation: A client's decision to discontinue services before completing an agreed-upon program does not, by itself, establish grounds for a refund or reversal of payment.
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Dissatisfaction With Results: Unfavorable relationship outcomes, including separation, divorce, breakup, or a decision not to continue the relationship, do not automatically constitute nonperformance or failure to deliver professional services.
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Payment Disputes: Clients are encouraged to contact the practice directly regarding billing concerns before initiating a dispute through PayPal, CareCredit, a credit card issuer, or another payment provider. This provision does not restrict any legally protected right to dispute a transaction.
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Documentation of Services: In the event of a payment dispute or chargeback, the practice reserves the right to provide the payment processor with appropriate supporting documentation, including signed agreements, enrollment acknowledgments, transaction records, appointment records, and evidence of services rendered or professional resources reserved, consistent with applicable confidentiality and privacy laws.
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Outstanding Financial Obligations: Clients remain responsible for legitimate unpaid balances under their service agreement, subject to applicable law. The practice reserves the right to pursue lawful collection procedures when appropriate.
Client Acknowledgment: By booking, enrolling, submitting payment, or signing the applicable agreement, clients acknowledge that they understand the practice's non-refundable payment policy, the financial commitment associated with their selected program, and the absence of guaranteed therapeutic outcomes.
The purpose of these provisions is to establish clear financial expectations, protect professional time and resources reserved for each client, and reduce misunderstandings regarding voluntary withdrawal, unused sessions, and payment disputes.
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15. Minors, Custody, and Office Safety
Services involving minors require applicable parental or guardian consent and age-appropriate confidentiality explanations, subject to state law. The practice does not provide custody evaluations or visitation recommendations in its treatment role. Weapons are not permitted in the office, consistent with applicable law and safety policies.
16. Acknowledgment and consent
I acknowledge that I have had an opportunity to review this document, ask questions, and understand the nature of services, limits of confidentiality, appointment practices, and financial terms. I understand that separate notices and service-specific enrollment agreements may apply. My signature indicates informed consent to the identified services, not a waiver of legal rights. An electronic acknowledgment may be used where legally valid.
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(Electronic Signature Required Upon Booking/Before Payment Is Made)
