Consent Form
INFORMED CONSENT & REFUND POLICY
Shawn McBride, MA, LCPC
The Couples Counseling & Coaching Center, LLC
Shawn McBride Therapy, LLC
1. Description of Practice
Shawn McBride, MA, LCPC is a Licensed Clinical Professional Counselor in the State of Maryland (License #LCPC-13229). Services are provided through The Couples Counseling & Coaching Center, LLC and Shawn McBride Therapy, LLC.
Services may include, but are not limited to:
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Individual counseling
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Couples counseling
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Premarital counseling
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Relationship intensives
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Pastoral counseling
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Coaching services
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Structured therapeutic and educational programs
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Assessments and evaluations
Shawn McBride, MA, LCPC is solely responsible for all psychotherapy services delivered under this practice.
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1A. Scope of Services & Provider Designation (Team Members)
Shawn McBride, MA, LCPC is the only licensed clinical provider rendering psychotherapy services under this practice.
Any services provided by team members, associates, facilitators, coaches, pastoral counselors, or staff members other than Shawn McBride, MA, LCPC are not psychotherapy and are provided exclusively under a coaching and/or pastoral counseling framework.
This applies to all services delivered:
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In-state or out-of-state
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Virtually or in person
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Individually or in group settings
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Clients acknowledge and understand that:
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Coaching and pastoral counseling services are not clinical psychotherapy
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These services do not involve diagnosis or treatment of mental health disorders
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Coaching and pastoral counseling are educational, relational, spiritual, and growth-oriented in nature
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Different confidentiality, documentation, and professional standards may apply than those governing psychotherapy
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Participation in services with any provider other than Shawn McBride, MA, LCPC constitutes informed consent to receive coaching and/or pastoral counseling services, regardless of client location.
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2. Client Rights & Responsibilities
Clients have the right to:
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Ask questions about therapeutic, coaching, or pastoral approaches
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Decline any technique or intervention
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Receive respectful, ethical, and professional care
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Request referrals if services are no longer appropriate
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Review records in accordance with applicable laws
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Right to Discontinue Services
Clients may choose to discontinue therapy or coaching at any time. However, discontinuation does not alter financial responsibility for services already rendered or for time, clinical capacity, and resources reserved under a program or package agreement.
3. Nature of Therapy, Coaching, & Pastoral Counseling
Therapy, coaching, and pastoral counseling are collaborative processes that may involve emotional discomfort, increased self-awareness, exploration of relational patterns, and temporary increases in stress or conflict.
No specific outcome or result is guaranteed.
Clients receiving services from team members other than Shawn McBride, MA, LCPC acknowledge that such services fall under coaching or pastoral counseling, not psychotherapy, regardless of geographic location.
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4. Appointments & Session Structure
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Standard sessions are 55 minutes
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Sessions may be weekly, bi-weekly, or program-based
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Sessions begin and end on time
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Arriving more than 15 minutes late constitutes a missed session and is charged in full.
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5. Cancellation & Missed Appointment Policy
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Individual Sessions
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A minimum of 24 hours’ notice is required to cancel or reschedule
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Late cancellations or no-shows are charged the full session fee
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Fees must be paid prior to the next session
Intensives & Structured Programs
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A minimum of 14 days’ notice is required to cancel or reschedule
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Cancellations within 14 days are charged in full
Missed sessions are not refundable and may not be carried forward unless explicitly approved in writing.
6. Payment Structure
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Individual sessions are paid per session
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Packages, intensives, and multi-month programs require full payment or an approved payment plan at enrollment
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Enrollment secures reserved clinical time and resources and constitutes acceptance of all financial and refund policies
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Accepted forms of payment include credit cards, HSA, FSA, and approved third-party payment options.
Insurance is not accepted; superbills may be provided upon request.
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7. Program Commitment & Financial Responsibility
Six-Month Program Commitment & Financial Responsibility
The 6-Month Program is a structured clinical engagement designed to provide continuity of care, treatment planning, and reserved clinical availability over a defined time period.
By enrolling, the client understands and agrees that:
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The program is a time-based commitment, not a pay-per-session arrangement
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Clinical capacity, scheduling priority, and treatment planning resources are reserved in advance
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All program fees are earned upon enrollment and are non-refundable, regardless of attendance, participation level, or early termination initiated by the client
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Missed or unused sessions do not result in refunds or credits
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Sessions must be used within the agreed-upon program timeframe unless otherwise approved in writing
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Early termination by the client does not relieve financial responsibility for the program.
8. Refund Policy (All Services)
Refund Policy – No Exceptions
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All counseling, therapy, coaching, pastoral counseling services, packages, intensives, and multi-month programs are non-refundable.
Once enrolled, clients are financially responsible for the full program or package fee. No refunds or partial refunds will be issued for:
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Early termination by the client
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Missed or unused sessions
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Scheduling difficulties
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Emotional discomfort or dissatisfaction with pace
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Relationship outcomes or decisions made during services
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Changes in motivation, readiness, or commitment
Enrollment reflects informed consent, acknowledgment that clinical or program capacity has been reserved, and agreement to this policy.
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9. Therapist-Initiated Termination
If the therapist determines that continued treatment is no longer clinically appropriate, ethical, or safe, reasonable efforts will be made to provide referrals and transition support.
In such cases, unused sessions may be credited at the therapist’s discretion; however, no refunds are guaranteed. Decisions are based on clinical judgment, services rendered, and time already reserved.
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10. Transferability of Sessions
Unused sessions are non-transferable unless explicitly approved in writing by the therapist. Approval is rare and granted solely at the discretion of the practice.
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11. Chargebacks & Payment Disputes
Clients agree not to initiate chargebacks or payment disputes for services rendered or programs enrolled in.
Initiating a chargeback may result in:
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Immediate termination of services
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Documentation submitted to the payment processor
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Referral to collections for unpaid balances
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12. Confidentiality & Legal Limits
All services are confidential within the limits of the law, including but not limited to:
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Risk of harm to self or others
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Abuse or neglect of a child, elderly adult, or vulnerable person
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Court orders or other legal mandates
13. Communication Policy
Text and email are used for scheduling and administrative purposes only. Therapy, coaching, or pastoral counseling is not conducted via text, email, or social media.
14. Informed Consent Acknowledgment
By scheduling an appointment, enrolling in a program, or submitting payment, you acknowledge that you have read, understand, and agree to all terms outlined in this Informed Consent & Refund Policy.
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Office Location
3060 Mitchellville Rd, Suite 106
Bowie, MD 20716
