I understand that counseling is a confidential relationship and that my records cannot be disclosed without my written consent, as protected by law. I understand that Lynn Stravecky is required by state and Federal law to notify proper authorities without my written consent in the case of a threat of suicide, a threat of homicide, suspected child abuse, and spousal abuse. Further, I give my consent for Lynn Stravecky to contact the persons named herein, where I have indicated agreement. LESS THAN 24 HOUR CANCELLATION NOTICE WILL BE BILLED A $100.00 FEE. SIGNING DOCUMENT IS AGREEING TO MY OFFICE POLICY CHARGE.