Release Form

Consent & Agreement

I/we desire to receive counseling and ministry from Christus Biblical Counseling. I/we make the following acknowledgements and agreements and provide the following consents:

The counseling will be by a counselor who is trained in biblical counseling who may or may not have other certifications or degrees.
A basic principle of biblical counseling is that the Bible is sufficient to understand how to live a God pleasing life.
The counseling I/we receive will be based upon scriptural principles rather than principles of psychology or psychiatry.
The counseling I/we will receive will be based on conclusions that the Bible is inerrant and authoritative and contains God’s answers to issues that arise out of the circumstances, relationships and behavior of life.
The counseling I/we will receive will reflect the counselor’s understanding of the Bible and how the principles of scriptures apply to the problems, questions or issues involved.
I/we understand there may be counseling trainees (those being trained in biblical counseling) present during the counseling sessions and they will abide by the confidentiality statement explained in #8 below.
Christus Biblical Counseling requires a $35 deposit which is forfeited for unplanned cancellations (24 hours’ notice). I Understand if I leave counseling or graduate from counseling without an unplanned cancellation the deposit is returned.
If a dispute arises concerning the counseling or between the counselor and counselee involved, or with Christus Biblical Counseling (“the dispute”), there shall be no lawsuit initiated and the claim cannot be filed in any state or federal civil court. Rather, the dispute must be resolved as follows:
The parties hereby exercise their election to submit any disputes or claims to Christian resolution. The parties understand that the Bible commands them to make every effort to live at peace and resolve disputes with each other in private or within the Christian church (See Matthew 18:15-20; I Corinthians 6:1-8). If all parties agree, the dispute can be submitted to the binding arbitration decision of agreed upon local pastors and/or church leaders who would decide and judge between the parties, applying the principals of 1 Corinthians 6 and Matthew 18, as well as other applicable scriptures. The parties understand that Christian dispute resolution methods shall be the sole remedy for any such dispute or claim. The parties further agree that if they fail to agree to submit the dispute or claim to local pastors and/or church leaders, then they herby agree that any such claim or dispute arising from or related to the counseling by Christus Biblical Counseling , or with a Christus counselor shall be settled by legally binding Christian arbitration, in accordance with the Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, a division of Peacemaker Ministries (1537 Avenue D, Suite 352, Billings, MT), including its Rules as found at www.HisPeace.org.
Counseling with Christus, including statements made during counseling, shall remain confidential, with the following qualifications and exceptions;

Counselors shall be free to discuss counseling sessions and cases with other Christus counselors in order to gain the benefit of additional insight and input;
Counselors shall be entitled to seek a confidential legal opinion or advise from an attorney when it is deemed appropriate and helpful;
If any Christus policy concerning the reporting of child abuse or child neglect mandates a report to the States CPS, CYFD, or the like or other authorities in compliance with the laws of the State of Indiana or New Mexico, then such a report will be made;
If a suicide risk is indicated, the counselors may seek necessary help and make whatever reports or disclosures as they deem to be proper and necessary;
If a counselee indicates an intention to commit a crime, such intention may be reported and disclosed to the proper authorities;
If the counselee is a member of a local church and if the Christus counselor deems it necessary or helpful to communicate information or fact to the pastor of the counselee’s local church, they may do so.

I have read and understand the above provisions, and I/we hereby acknowledge and agree to all the above terms, including, but not limited to waiver of redress (lawsuit) in the civil court systems, and agreeing that any and all disputes be resolved through Christian resolution as detailed above.

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