Donald Goodman, LCSW

All information disclosed within sessions and the written records pertaining to those sessions are confidential and may not be revealed to anyone without your (client’s) written permission, except where disclosure is required by law. Most of the provisions explaining when the law requires disclosure were described to you in the Notice of Privacy Practices that you received with this form.

Some of the circumstances where disclosure is required by the law are: where there is a reasonable suspicion of child, dependent or elder, abuse or neglect; and where a client presents a danger to self, to others, to property, or is gravely disabled.

Disclosure may be required pursuant to a legal proceeding. If you place your mental status at issue in litigation initiated by you, the defendant may have the right to obtain the therapy records and/or testimony by Donald Goodman. In couple and family therapy, or when different family members are seen individually, confidentiality and privilege do not apply between the couple or among family members. Donald Goodman will use his clinical judgment when revealing such information. Donald Goodman will not release records to any outside party unless he is authorized to do so by all adult family members who were part of the treatment.

If there is an emergency during our work together, or in the future after termination, where Donald Goodman becomes concerned about your personal safety, the possibility of you injuring someone else, or about you receiving proper psychiatric care, he will do whatever he can within the limits of the law, to prevent you from injuring yourself or others and to ensure that you receive the proper medical care. For this purpose, he may also contact the police, hospital or the person whose name you have provided on the biographical sheet.

It is very important to be aware that e-mail and cell phone (also cordless phones) communication can be relatively easily accessed by unauthorized people and hence, the privacy and confidentiality of such communication can be easily compromised. E-mails, in particular, are vulnerable to such unauthorized access due to the fact that servers have unlimited and direct access to all e-mails that go through them. Faxes can be sent erroneously to the wrong address. Please notify Donald Goodman at the beginning of treatment if you decide to avoid or limit in any way the use of any or all of the above-mentioned communication devices. Please do not use e-mail or faxes in emergency situations. Also, please note that most insurance companies will not reimburse for phone sessions. Clients will be expected to assume the full fee if phone sessions are scheduled.

Due to the nature of the therapeutic process and the fact that it often involves making a full disclosure with regard to many matters which may be of a confidential nature, it is agreed that should there be legal proceedings (such as, but not limited to divorce and custody disputes, injuries, lawsuits, etc.), neither you (client) nor your attorney, nor anyone else acting on your behalf will call on Donald Goodman to testify in court or at any other proceeding, nor will a disclosure of the therapy records be requested.

Donald Goodman consults regularly with other professionals regarding his clients; however, the client’s name or other identifying information is never mentioned. The client’s identity remains completely anonymous, and confidentiality is fully maintained.

* Considering all of the above exclusions, if it is still appropriate, upon your request, Donald Goodman will release information to any agency/person you specify unless Donald Goodman. concludes that releasing such information might be harmful in any way.