Provider: Melissa Deaton
Provider License: LPCC #260927
Contractual Agreement for Consultation with Deaton and Deaton Counseling and Consulting
By signing below, I, the individual seeking consultation, hereby agree to enter in a professional Consultation relationship with a contracted member of the Deaton and Deaton Counseling and Consulting. This consultation will be defined as a collaborative relationship between two psychotherapists, with the Consultee continuing his/her role and responsibility as primary therapist in making clinical decisions regarding treatment. The Consultant's role in providing Consultation is to advise the Consultee regarding utilizing the 8 Phase EMDR Therapy Model and other therapy models in an effective manner without imposing requirements pertaining to the Consultee's primary therapist role. It should be further noted that the Consultant should not be misconstrued as a supervisor. The Consultee will maintain total clinical, ethical and legal responsibility in the delivery of all treatment aspects with his/her clients. Hence, the Consultant cannot be held or perceived as being legally liable for the conduct and decisions made by the Consultee in clinical practice and/or application of Psychotherapy.
Deaton and Deaton Counseling and Consulting will process payment with each individual Consultee througha
secure online portal hosted by Square. Consultees must submit Debit or Credit card information with the consultant and agree to auto-payment immediately following each consultation session or on a monthly payment plan as agreed upon by both parties. Consultation rates will vary based on the following factors: Consultant providing the consultation Individual vs. group consultation Size of group consultation
The length, frequency, price and location of consultation will be mutually agreed upon, with any disputes settled at the discretion of the Consultant. No credit or refund will be given for missed consultation. Should a Consultee be unable to complete a scheduled certification assignment, an individual makeup consultation may be arranged at the agreed hourly rate.
Confidentiality is paramount and required relative to discussion held and cases reviewed. During group consultation, confidentiality is required by all group members, concerning member performance and client/case information. Signed releases by Consultees are required on all cases discussed. It is the Consultee's responsibility to maintain signed Release of Information in the client's file. The Consultee is also required to maintain his/ her own records regarding consultation. It is the policy of Deaton and Deaton Counseling and Consulting to provide services to all persons without regard to race, color, national origin, religion, sex, age, or disability. No person shall be excluded from participation in, or be denied the benefits of any service, or be subject to discrimination because of race, color, national origin, religion, sex, age, or disability.
If you believe you have been denied a benefit of service because of your race, color, national origin, religion, sex, age, or disability, you may file a Complaint of Discrimination with the Office or Facility Administrator, either verbally or in writing. If you choose to file your complaint in writing, please include your name, address, telephone number, and a brief description of what occurred which led you to believe you were discriminated against. In this way the appropriate person may respond to your complaint. You may also file a Complaint of Discrimination by contacting the external agency listed below.
275 E. Main Street, 2E-O Frankfort, KY 40621 CHFS.Listens@ky.gov Phone: (502) 564-5497 (800) 372-2973
You will not be intimidated, harassed, threatened, or suffer any penalty because you file a complaint. Any penalty or reprisal against you or any other involved person is prohibited by law.