I understand that I have the following rights with respect to my free Symptometry Consultation:
1.I have the right to withhold or withdraw consent at any time without affecting my right to future care ortreatment nor risking the loss or withdrawal of any self-help program benefits to which I would otherwise be entitled.
2.The laws that protect the confidentiality of my medical information also apply to internet and telephone consultations. As such, I understand that the information disclosed by me during the course of my therapy is generally confidential. However, I also understand that there are both mandatory and permissive exceptions to confidentiality, including, but not limited to reporting child, elder, and dependent adult abuse; expressed threats of violence towards an ascertainable victim; and where I make my mental or emotional state an issue in a legal proceeding.
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