Professional Disclosure Statement Introduction Counselors in North Carolina are mandated to provide a Professional Disclosure Statement “to each client prior to the performance of professional counseling services” (21 NCAC 53 .0204). This requirement aligns with the American Counseling Association’s Code of Ethics (ACA, 2005) which requires counselors to “review in writing and verbally with clients the rights and responsibilities of both the counselor and the client” (A.2.a. Informed Consent). The ACA specifies that the informed consent must include the nature of all services provided, counselor credentials and relevant experience, fees, billing information, confidentiality, supervision arrangements, how records will be handled, and more. As with any informed consent, the goal is to ensure that both the client and the counselor understand the nature of the relationship and the types of services that can be expected.
Each licensure type (LPCA, LPC, and LPCS) has specific requirements regarding what needs to be included in their Professional Disclosure Statement:
- LPC Associate (LPCA) Instructions for preparing your Professional Disclosure Statement
- LPC – Instructions for preparing your Professional Disclosure Statement
- LPC Supervisor (LPCS) Instructions for preparing your Professional Disclosure Statement
Professional Disclosure forms