4757.12 Professional disclosure statement.
4757.12 Professional disclosure statement.
(A) A person who is licensed or registered under this chapter, and a person or agency that employs a person licensed or registered under this chapter, may charge a client or receive remuneration for professional counseling, social work, or marriage and family therapy services only if one of the following applies:
(1) Prior to the performance of services, the client is furnished a copy of a professional disclosure statement containing the information described in division (B) of this section;
(2) A professional disclosure statement containing the information described in division (B) of this section is displayed in a conspicuous location at the place where the services are performed and a copy of the statement is provided to the client upon request.
(B) The professional disclosure statement required by division (A) of this section shall contain the following:
(1) The name, title, business address, and business telephone number of the professional clinical counselor, professional counselor, social work assistant, social worker, independent social worker, independent marriage and family therapist, or marriage and family therapist performing the services;
(2) The formal professional education of the person performing the services, including the institutions the person attended, the dates attended, and the degrees received from them;
(3) The areas of competence in the field in which the person is licensed or registered and the services the person provides;
(4) In the case of a person who is engaged in a private individual practice, partnership, or group practice, the person’s fee schedule, listed by type of service or hourly rate;
(5) At the bottom of the first page of the disclosure statement, the words, “This information is required by the counselor, social worker, and marriage and family therapist board, which regulates the practices of professional counseling, social work, and marriage and family therapy in this state.” and, immediately beneath those words, the name, address, and telephone number of the board.
Effective Date: 2002 HB374 04-07-2003