MANDATORY DISCLOSURE STATEMENT
Alarcon Healings LLC
885 Nile Street
Aurora, Co 80010
Bianca is a Registered Psychotherapist please note that Colorado State law requires I disclose the following statements: A Registered Psychotherapist is a psychotherapist listed in the State’s database and is authorized by law to practice psychotherapy in Colorado, but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain a registration from the state.
Other forms of Mental health practitioners are as follows:- A Certified Addiction Counselor I (CAC I) must be a high school graduate or equivalent, complete required training hours and 1,000 hours of supervised experience. - A Certified Addiction Counselor II (CAC II) must be a high school graduate or equivalent, complete the CAC I requirements, and obtain additional required training hours, 2,000 additional hours of supervised experience, and pass a national exam. - A Certified Addiction Counselor III (CAC III) must have a bachelor’s degree in behavioral health, complete CAC II requirements, and complete additional required training hours, 2,000 additional hours of supervised experience, and pass a national exam. - A Licensed Addiction Counselor must have a clinical master’s degree, meet the CAC III requirements, and pass a national exam. - A Licensed Social Worker must hold a master’s degree from a graduate school of social work and pass an examination in social work. - A Licensed Clinical Social Worker must hold a master’s or doctorate degree from a graduate school of social work, practiced as a social worker for at least two years, and pass an examination in social work. Page 2 of 3 - A Psychologist Candidate, a Marriage and Family Therapist Candidate, and a Licensed Professional Counselor Candidate must hold the necessary licensing degree and be in the process of completing the required supervision for licensure. - A Licensed Marriage and Family Therapist must hold a master’s or doctoral degree in marriage and family counseling, have at least two years post-master’s or one year post-doctoral practice, and pass an exam in marriage and family therapy. - A Licensed Professional Counselor must hold a master’s or doctoral degree in professional counseling, have at least two years post-master’s or one year postdoctoral practice, and pass an exam in professional counseling. - A Licensed Psychologist must hold a doctorate degree in psychology, have one year of post-doctoral supervision, and pass an examination in psychology.
Bianca has successfully passed the Colorado Mental Health Profession’s Jurisprudence Examination, and is a registered Psychotherapist in the state of Colorado, Bianca has completed highschool and some college courses to attain a degree in an Dental assisting, Bianca has also completed a 9 month certificate program at The School of Intuitive Studies, Bianca completed Reiki level 3 (master) with LIsa Powers Reiki Master, Bianca is BLS certified and has attended HIPPA compliance trainings. Various applicable trainings can be presented upon request.
The practice of licensed or registered persons in the field of psychotherapy is regulated by the Mental Health Licensing Section of the Division of Professions and Occupations. The Board of Psychotherapy can be reached at 1560 Broadway, Suite 1350, Denver, Colorado 80202, (303) 894-7800.
As a client you are entitled to receive information about the methods of therapy, the techniques used, the duration of therapy, if known, and the fee structure.
You or the minor being consented for (the client) may seek a second opinion from another therapist or may terminate therapy at any time.
In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licensed, registers, or certifies the licensee, registrant, or certificate holder.]
The information provided by the client during therapy sessions is legally confidential in the case of licensed marriage and family therapists, social workers, professional counselors, and psychologists; licensed or certified addiction counselors; and registered psychotherapists, except as provided in § 12- 245-220 and except for certain legal exceptions that will be identified by the licensee, registrant, or certificate holder should any such situation arise during therapy.
Typically, the information provided by and to the client during therapy sessions is legally confidential and cannot be released without the client’s consent. There are exceptions to this confidentiality (see below), some of which are listed in section 12-43-218 of the Colorado Revised Statutes and the HIPAA Notice of Privacy Rights, as well as other exceptions in Colorado and Federal law. Exceptions to therapist-client confidentiality include: a. I am required to initiate a mental health evaluation if a client is imminently dangerous to self or to others, or gravely disabled, as a result of a mental disorder; b. I am required to report any suspected incident of child abuse or neglect to law enforcement; c. I am required to report any threat of imminent physical harm by a client to law enforcement and to the person(s) threatened; d. I am required to report if you disclose or I observe that a child, an incompetent or disabled person, or an at-risk elder person is suffering or at imminent risk of abuse, neglect or exploitation; e. I am required to report any suspected threat to national security to federal officials; f. I may be required by Court Order to disclose treatment information. If abuse or neglect is disclosed under the conditions given above, I am mandated by Colorado law to report such information to an appropriate state agency. If feasible, you will be informed accordingly.
A registered psychotherapist is a psychotherapist listed in the state’s database and is authorized to practice psychotherapy in Colorado but is not licensed by the state and is not required to satisfy any standardized educational or testing requirements to obtain registration from the state.
I have read the preceding information and understand my rights as a client or as the client’s responsible party.
Print Client’s Name Client’s or Responsible Party’s Signature Date If signed by Responsible Party, please state relationship to client and authority to consent