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Professional Disclosure Statement-Revised

Professional Disclosure StatementAnd Consent for Mental Health Counseling ServicesCynthia Dowdy, PhD, NCC, LPCN ational Certified Counselor since 1993- Certificate #31719 Licensed Professional Counselor in North Carolina License #3694I invite you toread this prior to selecting me as your counselor. This document is part of the Standards ofPractice of the North Carolina Board of Licensed Professional Counselors (LPC) as stated in Section 90-343 ofthe LPC Act. The Disclosure Statement is designedto inform you of my Professional credentials, types ofservice offered, fee schedule, and therapeutic orientation and in Sociology, Oklahoma State University- in Community Counseling, Oklahoma State University- in Counselor Education, Kansas State University 2001 Teaching Experience in North CarolinaVisiting Assistant Professor- Counselor Education Department at NCSU (2002-2003)Counseling ExperienceCareer development and transitionDisability and illness adjustmentDepressionLearningdisabilities Adult ADDLife transitionsAddictive behaviors: alcohol and drug abuse; gambling.

professional manner consistent with ethical standards. It is impossible to guarantee any specific results regarding your counseling goals because the outcome is dependent on your work as well as mine.

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