Connection Point Biblical Counseling

2107 Emory Street

Covington, GA 30014

Phone: 470-782-9095

Notice of Policies and Practices to Protect the Privacy of Your Health Information

This Notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information.  Please review it carefully. Your consent to this Notice will be required at the first session. 

I may use or disclose your Protected Health Information (PHI) for treatment purposes with your consent.  To help clarify these terms, here are some definitions:

       "PHI" refers to information in your health record that could identify you.

       "Treatment" is when I provide, coordinate or mange your health care and other services related to your health care.  An example of treatment would be when I consult with another health care provider.

       "Use" applies only to activities within my office, such as sharing, employing, applying, utilizing, examining, and analyzing information that identifies you.

       Disclosure applies to activities outside of my office, such as releasing, transferring, or providing access to information about you to other parties.

I may use or disclose PHI for purpose outside of treatment when your appropriate authorization is obtained.  An "authorization" is written permission above and beyond the general consent that permits only specific disclosures.  In those instances when I am asked for information for purposes outside of treatment, I will obtain an authorization from you before releasing this information.  I will also need to obtain an authorization before releasing your process notes.  Process notes are notes I have made about our conversation during a private, group, joint or family counseling session.  These notes are given a greater degree of protection than PHI.

You may revoke all such authorizations (of PHI or psychotherapy notes) at any time, provided each revocation is in writing.  You may not revoke an authorization to the extent that I have relied on that authorization.

I may use or disclose PHI without your consent or authorization in the following circumstances:

Child Abuse:  If I have reasonable cause, on the basis of my professional judgment, to suspect abuse of children with whom I come into contact in my professional capacity, I am required by law to report this to the Administration for Children's Services.

Adult and Domestic Abuse:  If I have reasonable cause to believe that an older adult is in need of protective services (regarding abuse, neglect, exploitation or abandonment), I may report such to the local agency which provides protective services.

Judicial or Administrative Proceedings:  If you are involved in a court proceeding and a request is made about the professional services I provided you or the records thereof, such information is privileged under state law, and I will not release the information without your written consent, or a court order.  The privilege does not apply when you are being evaluated for a third party or where the evaluation is court ordered.  You will be informed in advance if this is the case.

Serious threat to Health or Safety:  If you express a serious threat, or intent to kill or seriously injure an identified or readily identifiable person or group of people, and I determine that you are likely to carry out the threat.  I must take reasonable measures to prevent harm.  Reasonable measures may include directly advising the potential victim of the threat or intent.

Church Leadership:  If you are receiving funding for counseling sessions, I will be required to file periodic reports with your elders/pastors which shall include, where pertinent, history, diagnosis, treatment, and prognosis.

Patient's rights:

Right to Request Restrictions - You have the right to request restrictions on certain uses and disclosures of protected health information about you.  However, I am not required to agree to a restriction you request.

Right to Receive Confidential Communications by Alternative Means and at Alternative Locations - you have the right to request and receive confidential communication of PHI by alternative means and at alternative locations.  (For example, you may not want a family member to know that you are seeing me.  Upon your request, I will send communications to another address or phone number.)

Right to Inspect and Copy - You have the right to inspect or obtain a copy of PHI in my mental health record for as long as the PHI is maintained in the record.  However, I reserve the right to deny your access to PHI under certain circumstances.  On your request, I will discuss with you the details of the request and denial process.

Right to Amend - You have the right to request an amendment of PHI for as long as the PHI is maintained in the record.  However, I reserve the right to deny your request. Upon your request, I will discuss with you the details of the amendment process.

Right to an Accounting - You generally have the right to receive an accounting of disclosures of PHI for which you have neither provided consent nor authorization (as described in Section III of this Notice). On your request, I will discuss with you the details of the accounting process.

Counselor's Duties:

I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI. 

I reserve the right to change the privacy policies and practices described in this notice.  Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.

If I revise my policies and procedures, I will provide you with a revised notice by mail or in person.

If you are concerned that I have violated your privacy rights, or you disagree with a decision I made about access to your records, please bring this to my attention.

You may also file a formal grievance with the Director of Counseling.

This notice is in effect as of November 10, 2022.

Counseling Agreement

There are several conditions upon which counseling cases will be initiated:

1.    Counseling at Connection Point always takes precedence over all other outside counseling. If the client is involved with more than one counselor and conflicting views become confusing, the client must bring this to the attention of his/her counselor. This is for the client's benefit. We do not want to create confusion.

2.    Counseling will be done by one of our staff counselors. Recordings of sessions may be made, but we will ask permission first.

3.    The counseling you receive will be biblical counseling in which the Scriptures are the final authority in all cases. All counseling will be conducted in accordance with the counselor's understanding of the Scriptures.

4.    It should be understood that biblical counseling consists of the giving of scriptural advice and the practical application of the same to each person. The client is held fully responsible for how he or she implements that advice.

5.    You are expected to attend a Christ-centered, Bible teaching church regularly for at least the duration of counseling sessions. If you are not currently attending a church, we will be glad to make a church recommendation to you.

6.    If you are already a member of a church, we recommend you inform your pastor or an elder that you are receiving biblical counseling at Connection Point. We recognize and respect the authority of your church insofar as it strives to follow biblical principles in discipling and counseling its members. Therefore, we hope to involve your church and pastoral staff in the implementation of your spiritual care should the need arise. Additionally, many churches will partner with you and share the cost of counseling.

7.    Confidentiality is an important aspect of the counseling process, and we will carefully guard the information you entrust to us. However, absolute confidentiality is not Scriptural. In certain circumstances the Bible requires that facts be disclosed to selected others (e.g., pastoral staff members) involved in your spiritual oversight (Hebrews 13:17). If your church leadership should inquire, we will disclose to them only that information we believe is necessary for them to possess in order to fulfill their duty to provide adequate spiritual care for you (Acts 20:28). Please be assured that counselors prefer not to disclose personal information to others, and we will make every effort to help you resolve problems as privately as possible.

8.    We do not want to have financial hardship stand in the way of someone receiving the counseling they need. For that reason, our fees are based on a sliding scale. Please fill out our Application for Reduced Fees if you desire financial assistance.

9.    If a conflict should arise between the client and the counselor, both parties agree to resolve the dispute outside the secular court system by means of biblical conciliation under submission to, and the direction of, the elder board of the counselor's church and in cooperation with the pastoral leadership of the client's church (1 Corinthians 6:1-8).

10. We are confident that the Bible has all the information necessary for life and godliness (2 Peter 1:3). There are no problems between persons that the Bible fails to address either in general principles or specific directives. While the counselor does not profess to know all there is to know about biblical teaching and its application to life, they have studied the Bible extensively and how to apply Scripture to everyday life. We will do our utmost to help you do the same. We will also make a point of differentiating between God's commands and our suggestions. The counselor will also honestly tell you if they are stymied and will seek qualified assistance from others if it becomes necessary.

11. We do not give medical or legal advice.

12. We request that you notify your Counselor at least 24 hours before your scheduled appointment time if you need to cancel a session. Failure to do so will result in charges for the missed appointment. This charge should be paid before or at the time of your next appointment to continue in the counseling relationship. Exceptions are for sudden illnesses and emergencies only.

We welcome the opportunity to help you in whatever way we can. If you are interested in receiving biblical counseling from Connection Point and are in full agreement with the conditions stated above, please sign below as indicated.

I have read and understood the conditions for counseling set forth in this document and agree to enter into counseling in accordance with them:

Informed Consent

Biblical Basis

We are confident that the Bible has all the instruction necessary for life and godliness (2 Peter 1:3-4). Your counseling will be biblically based in which the Scriptures are, in all cases, the final authority (2 Timothy 3:16-17). Our counselors do not pretend to know all there is to know about biblical teaching and its application to life; nevertheless, they do know much and will do their utmost to help you. While we believe that the Bible speaks to all of life and to all of its problems, we also believe that sometimes it takes careful thought and prayerful wisdom to know how to make those connections. Our counselors are trained to help guide you in applying biblical wisdom but will honestly tell you if they require additional assistance. It should be understood that biblical counseling consists of the giving of scriptural advice and the practical application of the same to each individual, yet the client is held fully responsible for how he or she implements that advice (James 1:23-25).

The Biblical Counseling Team

Each member of our counseling team has a Master's degree in either counseling or theology, or is currently pursuing this degree. The use of the word "counselor" in this document can equally refer to a pastoral counselor, biblical counselor, or a person trained in biblical counseling. Counseling trainees may be invited to join the counseling sessions to observe the counsel; however, they are bound to the same requirements of confidentiality as stated below. Connection Point counselors are not trained as and do not counsel as licensed psychologists, licensed psychiatrists, state certified therapists, or any other type of professional mental health care provider. Consequently as they should not be expected to follow the methods of such specialists, and under Georgia law, no such licensing is required. Their purpose is to minister from the Word of God as peers of the clients. There will be no attempt to render a psychological evaluation or diagnosis. If you have significant legal, financial, medical, or other technical questions, you should seek advice from an independent professional.

Confidentiality

Confidentiality is an important aspect of the counseling process. We carefully guard the information you entrust to us to the fullest extent possible. However, we do not promise confidentiality. Your counselor reserves the right to consult with other counselors or pastors at Connection Point for the purpose of providing the highest level of care. Additionally, there are times when counseling information may be shared outside the Connection Point context. Those exceptions would include, but are not limited to the following: (1) if a person expresses intent to harm himself/herself or someone else; (2) other credible intent to harm self or others; (3) if there is evidence or reasonable suspicion of abuse against a minor, child, elder person, or dependent adult; (4) the intent to take criminal actions or violence against another person; (5) active suicidal thoughts or intentions; (6) if/when the counselor consults with their supervision; Counselors reserve the right and discretion to contact any and all appropriate entities when, as a result of the counseling, it is clear that a crime has been committed or is about to be committed or the safety and welfare of any person (including the client) is in jeopardy. The counselor is not required to notify the client in advance of any such contact with the appropriate entities.

Each counseling office at Connection Point utilizes closed circuit video cameras. These cameras record picture only. They do not record voice. Video records are securely stored and made a part of Connection Point's permanent records. Cameras are used exclusively for office protection and liability reduction. We may occasionally request that your sessions are recorded for training purposes. You are in no way obligated to allow this.

Please be aware that your counselor is not a licensed psychologist, licensed Marital or family therapist, or licensed counselor under the authority of any state or national certifying board or organization. Consequently, communications between you and your counselor are considered privileged communications as defined by Georgia law. This means that, in a legal proceeding, a judge may compel disclosure of any statements you make to your counselor.

Release of Liability

My electronic signature below indicates my informed consent to the above guidelines. Additionally, by signing this document. I am, of my own free will knowingly authorizing Connection Point to render Biblical counseling and/or referral services to me. I declare that I am fully capable of discerning good and bad advice, and release my counselor, Connection Point, its staff, employees, or any other associated ministry or organization from any legal liability, claim, or litigation arising from my participation in this voluntary ministry. I affirm that no guarantee or assurance of any kind has been made to me with respect to the expected results of counseling. I have been informed of the nature and purposes of Biblical counseling and that my consent can be revoked orally or in writing prior to and/or during the counseling session.

Furthermore, I understand that the counselor to which I am assigned is not licensed, nor is required to be licensed, by the State of Georgia or any national certifying organization, as a professional counselor, social worker or therapist. I understand that I will not be given a psychological diagnosis based on the current Diagnostic and Statistical Manual of Mental Disorders. I also understand that those who provide care are not trained as and do not counsel as licensed psychologists, licensed psychiatrists, state certified therapists, or any other type of professional mental health care provider. I understand that I will receive Biblical guidance based on the teachings and authority of God's Word.

I have read the conditions for counseling set forth in this Informed Consent Form and agree to release Connection Point, its staff, counselors, and employees from any legal liability, claim, or litigation arising from my participation in this voluntary ministry. If you agree, please enter your name below which the parties agree will be your electronic signature: