Informed Consent Form

Biblical Basis ~ Firmly Rooted bases all counseling on Biblical principles rather than on secular philosophies.  Firmly Rooted (herein after referred to as FR) believes that Scripture is necessary and sufficient to guide us and instruct us in all things pertaining to life and godliness (2 Peter 1:3-4).  FR has a goal of helping you build a strong personal relationship with God the Father, through His Son, Jesus Christ, by means of the Holy Spirit, which ultimately is the best way FR can help you.

Disclosure ~ We are not psychologists or licensed mental health professionals and cannot provide you with assistance in the treatment of certain mental, emotional, or behavioral problems.  If you believe that you require the assistance of a professional counseling service, or you are presently under the care of a psychologist, psychiatrist, or other licensed mental health professional, FR encourages you to seek such help.  In such cases, FR will nevertheless seek to encourage you and offer supplemental Biblical counseling.

Confidentiality ~ Information disclosed during your Biblical Counseling will be held in strictest confidence.  However, under certain circumstances, the law may require FR to report information revealed during counseling.  These situations include, but are not limited to, elder or child abuse or neglect, imminent danger of homicide or suicide, or a court-ordered subpoena.  In some instances, FR may seek the advice or assistance of a pastor or another counselor when necessary for the purposes of treatment planning only and your name and circumstances will remain confidential. 

Resolution of Conflicts ~ Since FR does not offer professional counseling, please read the following section carefully.  If you are in agreement, please print your name, sign the Release of Liability and return.  In order to offer you distinctively Bible-based counseling and to protect FR from unwarranted legal action, we ask persons seeking counseling to agree to the following:

I understand that when the term “counseling” or “counselor” is used herein, or otherwise by Firmly Rooted, it does not refer to psychological, state licensed professional, psychiatric, or clinical medical advice.  I acknowledge that the method and process by which Biblical counseling is provided by Firmly Rooted is different in many ways than a clinical or psychological counseling process.  I understand that any information disclosed during counseling will be held in strict confidence.  However, should the need arise to seek assistance; I hereby give permission for my information to be shared with another qualified person for the purpose of furthering the treatment goals.  Neither my name or identifying information will be communicated in such circumstances.

Release of Liability

In consideration that I am receiving Biblical counseling and not professional, psychiatric, or clinical medical advice, I hereby release, acquit, and forever discharge Firmly Rooted, and Kathryn Custer, and all participating counselors connected with Firmly Rooted, from any and all actions, courses of action, claims, demands, damages, costs, loss of service, expenses and compensation, on account of any and all known and unknown personal injuries, mental anguish or agitation, and damage claims to person or property resulting from or arising out of or related to counseling services provided by Firmly Rooted, Kathryn Custer and/or its agents and representatives in any way affecting the undersigned.