Farwa Farid

Registered Intern
Springbrook Hospital’s Partial Hospitalization Program (PHP)
(352) 600-3288

Professional Disclosure Statement

Thank you for the opportunity to work with you as we build a therapeutic relationship based on
mutual respect, trust, and authenticity.  As we begin our work together, I would like to discuss
the contents of this document as it serves to inform you of my background, understanding the
nature of our professional therapeutic relationship, your rights and responsibilities as a client,
and office policies and procedures.  Please read this document to achieve mutual understanding
about the provided counseling services.  If you have further questions today or in the future,
please bring them up and together we will discuss your questions or concerns.  Please see the
sections below on confidentiality and the document regarding consent for audiotaping. 

At Springbrook’s PHP you have the right to professional counseling services consistent with the
standards of the American Counseling Association (ACA).  You have the right to understand the
professional training and credentials of your counselor (see below).  You have the right to
individual privacy, dignity, and compassion.  You will not be discriminated against on the basis
of race, ethnicity, religion, gender, nationality, age, sexuality, socioeconomic status, or ability.  
(Refer to the ACA Code of Ethics at www.counseling.org/Resources/aca-code-of-ethics.pdf)

My Qualifications

I am a Mental Health Counseling Therapist/Counselor Intern registered with the state of Florida.
I have completed my Master’s degree in Clinical Mental Health Counseling in December 2024 at
Wake Forest University.  I have a Bachelor of Medicine, Bachelor of Surgery which is a medical
degree from the University of Health Sciences, Lahore.  I have previously worked in outpatient
and hospital settings for four years. I am qualified to counsel individual adolescents and adults,
couples, families, and groups under the supervision of Ms. Angela Conway, LMHC, MCAP
from Springbrook Hospital. I am getting trained in a variety of theoretical approaches and
counseling interventions.

Counseling Philosophy and Approach

As we work toward your goals and address your concerns, we will tap on your inner strength and
build on skills that serve to empower you.  As your therapist, I will support and guide while
following your lead as you progress through the therapy.  Some clients need a few sessions to
work on their presenting concerns and achieve their goals, while others may require months or
years of a therapeutic relationship to do so.  To best serve your unique needs, the frequency and
number of sessions will be discussed in our first meeting and will be re-evaluated on an ongoing
basis.

My theoretical orientation is eclectic and adapted to your needs. I draw on theories and
interventions from Person Centered Therapy, Cognitive Behavioral Therapy, Dialectical
Behavior Therapy, Mindfulness and Motivational Interviewing.  I view counseling as a vehicle
for promoting holistic health including but not limited to cognitive, emotional, social, spiritual,
and physical aspects of wellness.

Depending on your needs, I may introduce techniques including but not limited to mindfulness,
acceptance & commitment, emotion focused, breathing exercises, relaxation techniques and
more.  We will collaborate to find what is most helpful for you including out-of-session
activities, called “homework.”  Though we will attempt to work toward positive outcomes, there
is no guarantee of these in the counseling process.  There are important risks and challenges to be
aware of in therapy. It is important for you to know that sometimes participation in therapy
involves the exacerbation of symptoms, though the hope is that you will see improvement. 
Simply put, clients often feel worse before feeling better.  You may discover that you have
painful thoughts or feelings about people or situations of which you were previously unaware.  
You experience something, or have had experiences in the past, that require reconciliation, and
sometimes that process can be difficult, uncomfortable, and tiring.

This discomfort is partially responsible for “resistance” that many clients experience at various
stages of counseling. Resistance is usually a healthy, normal response to potential change, often
signaling an opportunity for growth and healing.  For instance, resistance may show up as
thoughts like “I am too busy”, “I can’t change anything” or “This is just the way I am”.   In
choosing to acknowledge resistance, you choose to expand your opportunities for healing and
growth.

Therapeutic Relationship

Throughout the counseling process, we will work together to evaluate our progress, discuss your
experience of the process, and to work toward goals and desired counseling outcomes.  Though
the therapeutic relationship is an intimate one, our relationship is entirely professional.  You will
be best served in counseling by a strictly professional therapeutic relationship, and with sessions
that focus exclusively on your goals and concerns.  I do not engage with clients socially nor
participate in social media of any kind, as I believe it could compromise confidentiality and
privacy that could have a negative impact on our therapeutic relationship.  I do not text clients
and prefer to not use email.  Email is not a completely secure or confidential means of
communication.  You should know that any emails I receive from you and any response I send
become a part of your medical record.  I request that you limit contact to the methods outlined in
the availability section below.

As further protection of you and the therapeutic relationship, please do not extend social
invitations or gifts to me or ask me to relate to you in any other way outside the professional
context of our therapy.  These limits are designed with your welfare in mind and allow for all
efforts to be directed toward your therapeutic concerns only.  Also, because we may live in the
same community, if I see you in a public setting, I will not acknowledge you unless you first
acknowledge me.  I think it is best that any public discussion be kept to brief and unrelated to
your treatment.  This policy is an extension of my respect for you and my desire to protect your
confidentiality and preserve the integrity of our therapeutic relationship.
 My Availability

I am available during the weekday hours, four days a week and unavailable nights, weekends,
and during some holidays or breaks.  I can be contacted exclusively through Springbrook’s PHP. 
For non-crisis communications, you may leave a voicemail for me at (352) 600-3288.   For
emergencies, please call 911 or go to the nearest hospital emergency room.

Schedule, Fees, and Payment

Springbrook’s counseling service is offered at no cost to adults 18 years and older, both
psychiatric patients and substance abuse patients who need more than the traditional outpatient
therapy and medication management. PHP patients attend the program for four 45-minute
sessions each day, five days a week, which provides the necessary coping skill building
opportunities to help them return to everyday life.

If you must cancel your appointment, please do so promptly so that your appointment time may
be given to someone else. 

If I need to cancel, I will make every effort to inform you of the necessity to cancel an
appointment as quickly as possible.  Inclement weather, illness or other emergency may
necessitate rescheduling and every effort will be made to reschedule within one week.  I will
inform you at least 1 week in advance of scheduled vacations.  When I am out of town or
otherwise unavailable, you may leave a message at (352) 600-3288.

Use of Diagnosis

Some health insurance companies will reimburse clients for counseling services and some will
not. In addition, most companies require that a diagnosis must be rendered if the client is going
to be reimbursed. Some conditions for which people seek counseling do not qualify for
diagnosis. If a qualifying diagnosis is appropriate in your case, I will inform you of the diagnosis
before we submit the diagnosis to the health insurance company. Any diagnosis made will
become part of your permanent insurance records

Use of Mind-altering Drugs or Alcohol

No smoking is allowed in the building. Please do not appear for a session under the influence of
any mind-altering drug, including alcohol. Should the situation occur, the therapy session will
not take place and your insurance will be charged in full for the session. Such an occurrence may
be considered grounds for termination of therapy.

About Confidentiality and Records

All counseling services are provided in compliance with Fl confidentiality laws, the Fl Board of
Licensed Professional Counselors and the ethical standards of the National Board of Certified
Counselors, and the American Counseling Association.  Everything discussed in counseling
sessions is voluntary and confidential.  Our communications become part of your clinical record,
which may be accessible to you upon request.  A combination of physical and electronic clinical
records is used.  All electronic records are stored in a secure on-line platform.  These records
include but are not limited to contact record, case notes, diagnosis, and copies of all new client
forms. The information you share is considered to be confidential and will not be shared with
anyone outside the office without your written consent, with the following exceptions:

 Evidence of possible abuse or neglect of a minor or dependent adult,

 Evidence of possible danger to the client or identified others,
 Evidence of possible danger of contagion of life-threatening diseases,
 A court order for disclosure,
 Involvement of a DSS worker or guardian ad litem, and
 A request for information from the parent of a minor.
 The counselor may discuss the content of counseling sessions under the direction of a
Qualified Supervisor who is held to the same professional standards of confidentiality
and its limits.
 The counselor may share your information with other clinicians employed at this site for
the purposes of case consultation. This sharing of information will only occur if it
presents as beneficial for your development and growth. All clinicians are bound by the
governing HIPAA laws and will comply with this confidentiality agreement.
 If you are under eighteen years of age, please be aware that the law may provide your
parents the right to examine your treatment records. It is your counselor’s general policy
to provide your parents/guardians only with general information about our work together,
unless it is felt that there is a high risk that you are being harmed, will seriously harm
yourself or will harm someone else. In this case, your parents will be notified of my
concern, as well as the appropriate authorities if necessary. Before giving them any
information, your counselor will discuss the matter with you, if possible, and do her best
to handle any objections you may have with what she is prepared to disclose.

Please note that in sessions with multiple clients (e.g., couples, families, groups) confidentiality
cannot be guaranteed. 

Referrals and Complaints

There is no guarantee of any specific results.  I can only guarantee that I will work with you to
achieve your goals and counseling outcome.  I encourage you to communicate any concerns
about your experience or counseling process so that I can attempt to address them appropriately. 
If it serves you best to have different or supplemental services, we can discuss referral to another
counselor or service who can best serve you.  You may also contact my PHP supervisor, Ms.
Angela Conway to address your concerns or any other aspects of the counseling process.  If your
concerns remain unresolved, you may contact the Florida Board of Licensed Professional
Counselors:
Board of Clinical Social Work, Marriage & Family Therapy, and Mental Health
Counseling
Department of Health
4052 Bald Cypress Way, Bin C75
Tallahassee, FL 32399-3290
Phone: 850-245-4339
Email: MQA.ConsumerServices@flhealth.gov
Website: http://www.floridahealth.gov/licensing-and-regulation/enforcement/index.html

Customer Contact Center

Monday – Friday
8:00 a.m. to 6:00 p.m. ET
Phone:(850) 488-0595
Fax: 850-488-0796

Acceptance of Terms and Consent for Services:

I, ______________________________________________________________________, give
permission for counseling services by Farwa Farid at Springbrook Hospital’s PHP I understand
that the individual providing services is a Mental Health Counseling Therapist/Counselor
Registered Intern under the supervision of appropriately credentialed Qualified Supervisor.  I
understand that any conference, evaluation, or relevant information concerning my counseling
services may be observed by and/or discussed with the appropriate supervisor(s). We agree to
these terms and will abide by its guidelines

________________________________________________ Date: ____________________

Client Signature

_________________________________________________Date: ____________________
Farwa Farid, Registered Intern