Guide

The professional disclosure statement a therapy intake packet needs

Summary

What a counselor professional disclosure statement must contain is set by your own state's licensing board, and the contents lists differ enough that no national template satisfies all of them. Colorado itemizes the elements in statute and requires a signature by the second visit. Texas requires the same material as signed informed consent. Virginia writes the duty into the standards of practice and prescribes no separate form. Find your own rule before you print an intake packet.

By Gale Editorial · Updated 2026-09-01. Every figure cited to a dated source. How we write.

Where the contents list comes from

From your own licensing board, and the shape it takes there is not the shape it takes next door. Colorado itemizes the elements in statute 1. Washington itemizes them in rule, and only for two certified credentials 2. Texas requires the same material under the name informed consent 3. Virginia writes the duty into the standards of practice and prescribes no separate document at all 4.

A professional disclosure statement is the written page a client reads at or before the first session, naming who you are, what you are licensed to do, what you charge, and where a complaint about you goes. That much is common ground. The contents list around it is state law, which is why a template that satisfies one board can be missing another board's required elements while looking finished.

Washington's disclosure rule binds certified counselors and certified advisers under chapter 18.19 RCW, and licensed mental health counselors are regulated under chapter 18.225 RCW instead 2, so a Washington LMHC reading that rule is reading a document written for somebody else's credential. The trap sits one line above the elements: read the applicability sentence first, then the list.

Finding your own board's rule

Two lookups, both on state sites, neither behind a paywall. Start with your licensing act, the chapter of the state code that creates your credential, then open your board's administrative rules, which is where an itemized contents list lives when one exists. Search both for disclosure, informed consent, and professional disclosure statement. Colorado's sits in statute at section 12-245-216, C.R.S. 1. Washington's sits in rule at WAC 246-810-031 2.

Read three things in the section before you read the elements: who it applies to, when the document has to reach the client, and what has to be signed by whom. The verbs differ by state. Washington requires the statement prior to starting a program of treatment 2, Colorado requires the information in writing during the initial client contact 1, and Texas requires a signed consent or signed written receipt before services are provided 3.

But the section you find is not the whole of what a first appointment owes a client.

Fee language at intake also touches obligations your board rule was not written to answer. The good-faith estimate rules of the NSA for office practice are a separate federal lookup. If you prescribe rather than counsel, there is a third, on a different board's site: whether your state wants a collaborative agreement or protocol.

Colorado: the elements are in the statute

Colorado writes the list into statute. Every licensee, registrant, or certificate holder in the psychotherapy professions provides the required information in writing to each client during the initial client contact 1. The elements run to identity, credentials, regulation and records: your name, business address and business phone, then the degrees, credentials, certifications, registrations and licenses you hold, and for each of them the education, experience and training required to complete it.

Two of the elements are about what happens when the relationship goes wrong. The form states that the practice of psychotherapy is regulated by the division, and gives an address and telephone number for the board that regulates you 1. It also states that a client's records may not be maintained after seven years, citing section 12-245-226 (1)(a)(II)(A) 1.

The signature has its own deadline. The client, parent or guardian signs the disclosure form not later than the second visit with the psychotherapist, unless that person is unable to write, or refuses or objects 1.

Colorado also names circumstances where the disclosure is not required at all, among them an emergency, psychotherapy administered under a court order or an involuntary procedure, a relationship whose sole purpose is a forensic evaluation, and a client incapable of understanding the disclosure who has no guardian 1.

Check the current edition before any of this goes onto a form. The text above is the 2024 edition of Title 12, which the state publishes marked as an uncertified printout, and subsection (1)(b)(I) was repealed by Senate Bill 24-115 effective August 7, 2024 1.

Washington: an element that cancels your fees

Washington puts the price of skipping the form inside the form. The disclosure statement must carry a statement that clients are not liable for any fees or charges for services rendered prior to receipt of the disclosure statement 2, and the same sentence sits in the statute behind the rule 5. Certified counselors and certified advisers provide the statement to each client prior to starting a program of treatment 2.

The statute puts the duty at the commencement of any program of treatment and requires the receipt to be acknowledged in writing by the certified counselor or certified adviser and the client 5. So the file needs two artifacts: the statement that went out and the acknowledgment that it arrived.

The rule's remaining elements point outward, at the regulator. The statement carries a copy of the acts of unprofessional conduct listed in RCW 18.130.180 together with the department's contact for complaints, plus signature and date blocks and a client attestation 2.

And it is not a document you write once.

Any change to the disclosure statement form or information requires all current clients to sign the updated form 2. A fee increase or a change of office starts a re-signature round through the active caseload. The current version of the rule was filed in February 2025 and took effect July 1, 2025 2.

Virginia: the duty without a prescribed form

Virginia carries the duty without prescribing the document. The counseling standards of practice require a licensee to provide clients with accurate information regarding the implications of diagnosis, the intended use of tests and reports, fees, and billing arrangements 4. The chapter sets out no separate, itemized disclosure statement to hand over. The obligation is a standard of practice you are held to, at the start of counseling and while it continues.

A duty written as a standard of practice is enforced the way other standards are, so the missing form is no permission to skip the page. The difference at the point of a complaint is evidentiary: a dated page the client signed shows what the client was told, and a recollection does not.

Writing the statement anyway is the safer default here, and it costs one page in the packet.

What goes in when no rule itemizes anything

Start from the ethics code and add whatever your board itemizes on top of it. The 2014 ACA Code of Ethics puts the categories in standard A.2.b: qualifications and credentials, the purposes and techniques of the services, continuation of services if the counselor becomes incapacitated or dies, and fees and billing arrangements including the procedures for nonpayment of fees 6. It is an ethics code and not law, and it prescribes no state's contents list.

The fee section is where a solo practice usually has more to say than a rule requires. The session rate, the cancellation window, what happens to an unpaid balance, and any sliding scale or pro bono slots you hold open all belong there, because that page is what a fee dispute later turns on.

The continuity clause is the one solo clinicians leave out. It names who will reach your clients and who holds the records if you cannot practice, which is the same drawer as the administrative work that falls due when a patient dies. Texas makes that plan an element of the consent document itself 3, and Colorado requires its own statement about how long records are kept 1.

Two habits close the gap between a compliant form and a compliant file: date each version on the page and keep the superseded ones, and re-read your board's section on the day the licence renewal notice arrives.

Common questions

Not everywhere. Texas requires the same material under the informed-consent heading and itemizes eight things the document must hold. Colorado calls it a mandatory disclosure and itemizes it in statute. Washington calls it a disclosure statement and itemizes it in rule. The practical move is to look up the term your own board uses, because searching a state code for the wrong noun returns nothing.

The deadline belongs to your state. Colorado has the client, parent or guardian sign no later than the second visit, unless that person is unable to write, or refuses or objects. Texas requires a signed consent or signed written receipt before services are provided. Washington requires delivery before a program of treatment starts, with written acknowledgment by both the counselor and the client.

In Washington the form itself must say that clients are not liable for any fees or charges for services rendered before they received it. That is Washington's answer, not a national one. The other rules quoted here state the timing without attaching a fee consequence in the same section, so read your own board's section rather than carrying Washington's result across a border.

In Washington, any change to the disclosure statement form or information requires all current clients to sign the updated form. The other states quoted here set no re-signature rule in the same section, so treat that one as Washington's. Either way, dating each version and keeping the superseded ones is what lets you show which page a given client received.

The ACA ethics categories are the workable floor: qualifications and credentials, the purposes and techniques of the services, what happens to a client's care if you become incapacitated or die, and fees and billing including the procedure for nonpayment. Add your licence number and title, the limits of confidentiality, and the address a complaint about you goes to.

Often not. Washington's disclosure rule reaches certified counselors and certified advisers under chapter 18.19 RCW, while licensed mental health counselors sit under a different chapter. Boards commonly write one chapter per credential, and social work, marriage and family therapy and psychology usually carry their own rulebooks. Read the applicability sentence at the top of a section before you trust its element list.

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References

  1. 1.Colorado General Assembly, Office of Legislative Legal Services (2024). Colorado Revised Statutes 2024, Title 12: Professions and Occupations. Colorado General Assembly (leg.colorado.gov). link ✓The Colorado mandatory disclosure under section 12-245-216, C.R.S.: who must provide it, delivery in writing during the initial client contact, the itemized contents including the credentials list and the regulation and seven-year records statements, the second-visit signature rule, the listed exceptions, and the 2024-edition and SB 24-115 caveats.
  2. 2.Washington State Department of Health / Office of the Code Reviser (2025). WAC 246-810-031: Disclosure statement to be provided to clients by certified counselors and certified advisers. Washington State Legislature, Washington Administrative Code. linkThe Washington element list for certified counselors and certified advisers: delivery prior to starting a program of treatment, the fee-liability sentence, the unprofessional-conduct copy and complaint-contact element, the signature, date and attestation blocks, the re-signature rule on any change, and the current version's filing and effective dates.
  3. 3.Texas Behavioral Health Executive Council and Texas State Board of Examiners of Professional Counselors (2026). Texas Behavioral Health Executive Council and Texas State Board of Examiners of Professional Counselors Rules. Texas Behavioral Health Executive Council (rulebook updated 03/25/2026; 22 TAC Chapters 681, 881-885). link ✓The Texas LPC informed-consent requirement in rule 681.35: a signed informed consent or signed written receipt before services, the eight itemized contents including licence restrictions, supervision, the Council's contact for reporting violations and the records plan on death, incapacity or practice closure, and the agency-employment exception.
  4. 4.Virginia Board of Counseling (2021). 18VAC115-20-130. Standards of practice.. Virginia Administrative Code (law.lis.virginia.gov). link ✓That Virginia locates the disclosure duty inside the standards of practice, requiring accurate information on the implications of diagnosis, the intended use of tests and reports, fees and billing arrangements, without prescribing a separate itemized disclosure document.
  5. 5.Washington State Legislature (2008). RCW 18.19.060: Information disclosure to clients. Washington State Legislature, Revised Code of Washington. linkThe statute behind the Washington rule: disclosure at the commencement of a program of treatment, written acknowledgment by both the counselor and the client, and the fee-liability sentence.
  6. 6.American Counseling Association (2014). 2014 ACA Code of Ethics. American Counseling Association. link ✓The ethical floor for contents where no board rule itemizes them: standard A.2.b on qualifications and credentials, purposes and techniques, continuation of services on the counselor's incapacitation or death, and fees and billing including procedures for nonpayment.

https://www.gale.care/for-providers/pq-therapy-disclosure-statement-intake · 6 sources. Competitor details are cited to dated public sources and maintained as they change; figures are estimates, not commitments. Synthetic demonstration.

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