Professional Disclosure Statement

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Brandon M. Robinson, LCAS, LCMHC, CCS
5561 McNeely Dr Ste 302
Raleigh, NC 27612
(919) 295-2188
brandonrobinson907@gmail.com
 
Professional Disclosure Statement
 
EDUCATION
Masters of Science, Rehabilitation Studies and Substance Abuse Counseling (June 2005)
            East Carolina University, Greenville, NC
Bachelor of Science, Psychology (June 2001)
            Western Michigan University, Kalamazoo, MI
 
LICENSURE AND ACCREDIDATION
Licensed Clinical Mental Health Counselor (LCMHC), honored by the North Carolina Board for NC Board of Licensed Clinical Mental Health Counselors    (2006 – Lic#5531)
Licensed Clinical Addiction Specialist (LCAS), honored by the North Carolina Substance Abuse Professional Practice Board (Lic#1540)
Certified Clinical Supervisor (CCS), honored by the North Carolina Substance Abuse Professional Practice Board (Lic#567)
Certified Clinical Interventionist, honored by the Love First Institute (2021)
POPULATION AND SERVICES
My education and 20 years of counseling experience have prepared me to counsel individuals, groups, families, and special populations such as substance abuse, mental health needs, persons with disabilities, adults, and adolescents.  I offer services that entail: addiction counseling specializing in family interventions, relapse prevention, solution focused and cognitive behavioral techniques, anger management, group based therapy, and family counseling.
 
COUNSELING SESSIONSAND PAYMENT
Counseling Relationship
During the time we work together, we will meet as scheduled for the amount of time allotted in an attempt to address person centered treatment objectives and goals.  This can be done in either an individual or group setting.  Although our sessions may be very intimate psychologically, ours is a professional relationship rather than a social one.  By acknowledging this document you understand that I cannot accept invitation to social gatherings, gifts, agree to write references for you, or ask me to relate to you in any other way than in the professional context of the counseling sessions.  You will be served appropriately in our sessions exclusively on your goals and concerns.
 
Client Rights
Some clients need only a few counseling sessions to achieve their goals, others require months or years of counseling.  As a client (or the parent of a client), you are in complete control and may end our counseling relationship at any time, although, I do ask you to participate in a formal “termination” session.  You also have the right to refuse or discuss modification of any of my counseling techniques or suggestions that you believe might not be helpful.
 
I accept legal and ethical standards governed by the state of North Carolina.  If at any time, for any reason, you are dissatisfied with the services, please let me know.  See “formal complaints”.
 
Formal Complaints (as defined by the North Carolina Board of Licensed Clinical Mental Health Counselors)
Formal complaints of a Licensed Professional Counselor’s unethical conduct shall bear the complainant’s signature, include the complainant’s address and telephone number, date and location of the alleged violation(s), a detailed description of the incident(s), and required signed releases.  Send the complaint via mail to:
North Carolina Board of Licensed Clinical Mental Health Counselors
P.O. Box  77819
Greensboro, NC 27417
(336) 217-6007
Record and Confidentiality
Through appropriate and meaningful assessment procedures, I will use diagnoses to help define and describe some of your problems that may exist.  All diagnosing information will be supported by the Diagnostic and Statistical Manual for Mental Health Disorders, Fourth Edition.
 
All of our communication becomes part of the clinical record.  Records are my property, but you have the right to the information within your record.  Most communications are confidential, but the following limitations and exceptions do exist: (a) you provide me with your consent to release information; (b) I have reasonable suspicion that you are a threat to yourself or someone else; (c) you disclose abuse or neglect a minor, elderly, person with a disability; (d) you disclose sexual contact with another mental health professional; (e) I am ordered by the court to disclose information; (f) you involve me in a lawsuit and I need to release specific information in order to receive compensation for services rendered; or (h) I am otherwise required by law to release information.  If I see you in public, I will protect your anonymity by acknowledging you only if you approach me first.
 
Fees
Clinical Assessments (both Mental Health and Substance Abuse) = $160.00.
Individual Sessions = $160.00 per hour or agreed upon amount of  $___________
Consultation/Family Therapy = $160.00 per hour
Intervention Prep (Module 1) meeting = $500
Case Management = $100.0 per hour
Blue Cross/Blue Shield accepted = co-pay TBD
Clinical Supervision for counselors = $175 – $225 per month
 
Cancellation Policy
A one-time no show/no call is allowed.  Thereafter, if a cancellation (via phone call, text message, or email) is not made within 24 hours of the scheduled appointment, then $50 charge will be billed prior to the subsequent counseling session.
 
Client Signature                                                                                                 Date
 
Legal Guardian (if applicable)                                                                            Date
 
Brandon Robinson, LCAS, LCMHC, CCS                                                                Date

EDUCATION

Masters and Education Specialist in School Psychology

  • Western Michigan University, Kalamazoo, MI

B.S., Psychology

  • Western Michigan University, Kalamazoo, MI
LICENSURE AND ACCREDITATION
  • Licensed Psychological Associate honored by the North Carolina Psychology Board (#6712)
  • Health Services Provider – Psychological Associate honored by the North Carolina Psychology Board
  • Licensed School Psychologist honored by the North Carolina Department of Public Instruction
  • Nationally Certified School Psychologist honored by the National Association of School Psychologists 
POPULATION AND SERVICES

My education and over twenty years of experience has prepared me to evaluate, diagnose, and counsel children and adolescents including special populations such as ADHD, autism, behavioral disorders, learning disabilities, and psychological conditions including depression, anxiety, etc. I offer services that entail: psychological and psychoeducational evaluations, individual counseling including solution-focused,  cognitive behavioral, and ACT techniques.

EVALUATIONS & COUNSELING SESSIONS AND PAYMENT

Psychological & Psychoeducational Evaluations

I will conduct an intake to determine the best evaluation path that is tailored to your child’s presenting needs. The assessment will aim to evaluate your child’s cognitive, academic, emotional, behavioral and/or executive functioning to assist in diagnosis, treatment planning, home/school recommendations, and/or diagnostic clarification. I will meet with the family to review the report and personal recommendations at the cessation of the entire evaluation. 

Counseling Relationship

During the time we work together, we will meet as scheduled for the amount of time allotted in an attempt to address person-centered treatment objectives and goals. Although our sessions may be very intimate psychologically, ours is a professional relationship rather than a social one.  By acknowledging this document you understand that I cannot accept invitations to social gatherings, gifts, agree to write references for you, or ask me to relate to you in any other way than in the professional context of the counseling sessions.  You will be served appropriately in our sessions exclusively on your goals and concerns.

Client Rights

Some clients need only a few counseling sessions to achieve their goals, others require months or years of counseling.  As a client (or the parent of a client), you are in complete control and may end our counseling relationship at any time, although, I do ask you to participate in a formal “termination” session.  You also have the right to refuse or discuss modification of any of my counseling techniques or suggestions that you believe might not be helpful.

I accept legal and ethical standards governed by the North Carolina Psychology Board, American Psychological Association, North Carolina Department of Public Instruction and National Association of School Psychologists.  If at any time, for any reason, you are dissatisfied with the services, please let me know.  See “formal complaints”. Additionally, should any questions or concerns arise that I am not able to effectively address, please contact Dr. Chelsea Bartel, clinical supervisor, at 919-677-0101 or bartel@3cfs.com 

Formal Complaints (as defined by the North Carolina Psychology Board)

Formal complaints of a Licensed Psychologists and Psychological Associates unethical conduct shall bear the complainant’s signature, include the complainant’s address and telephone number, date and location of the alleged violation(s), a detailed description of the incident(s), and required signed releases.  Send the complaint via mail to:

North Carolina Psychology Board
895 State Farm Road, Suite 101
Boone, NC 28607
(828) 262-22586007

Record and Confidentiality

Through appropriate and meaningful assessment procedures, I will use diagnoses to help define and describe some of the difficulties you or your child are experiencing.  All diagnosing information will be supported by the Diagnostic and Statistical Manual for Mental Health Disorders, Fourth Edition.

All of our communication becomes part of the clinical record.  Records are my property, but you have the right to the information within your record.  Most communications are confidential, but the following limitations and exceptions do exist: (a) you provide me with your consent to release information; (b) I have reasonable suspicion that you are a threat to yourself or someone else; (c) you disclose abuse or neglect to a minor, elderly, person with a disability; (d) you disclose sexual contact with another mental health professional; (e) I am ordered by the court to disclose information; (f) you involve me in a lawsuit and I need to release specific information in order to receive compensation for services rendered; or (h) I am otherwise required by law to release information.  If I see you in public, I will protect your anonymity by acknowledging you only if you approach me first.

Fees

ADHD Assessments: range from $800-$1,500.

Autism Assessments: $2,000.

Comprehensive Educational, Developmental, and Emotional/Behavioral Assessments: $1,500.

Educational or IQ only: $500

Individual Counseling Sessions: $150.00 per hour or agreed upon amount of  $___________
Consultation/Case Management: $100.0 per hour
Blue Cross/Blue Shield accepted: co-pay TBD
 

Cancellation Policy

While understanding there may be times an appointment is missed due to emergencies or obligations, COUNSELING CHOICES, PLLC  requires at least 24 hours’ notice on all cancelled appointments.  There is a $50.00 charge for failing to notify (i.e., text, email, phone call) within 24 hours. This fee will be invoiced and charged to the credit card on file. ***Please note, if 3 late cancellations occur during the duration of the evaluation and/or therapy enrollment, then subsequent late cancellations or no shows will result in a full charge of an out of pocket cost therapy session.