Rachel Natvig Professional Disclosure

Professional Disclosure Information
We disclose to each client the professional qualifications and experience of the supervised psychotherapist, those actions that constitute unprofessional conduct, and the method for filing a complaint or making a consumer inquiry.

Rachel Natvig, Ph.D. Psychotherapist

Qualifications and Experience of Rachel Natvig, Ph.D.

Formal Education:

Ball State University 09/1988-05/1997

Doctor of Philosophy

Boston College 09/1986-06/1988

Master of Arts

Training:

Foundational Training in Dialogue Therapy

The Institute For Dialogue Therapy

Poly Young-Eisendrath, Ph.D.

Worcester, VT

09/2018-11/2019

Certified Dialouge Therapist

Doctoral Internship Training, APA-approved

University of Maryland Counseling Services

College Park, MD

09/1991-06/1992

Verterans Administration

Boston, MA

09/1987-05/1998

Master's Internship

Experience in Practice of Psychotherapy:

Indianapolis Psychiatric Associates

Indianapolis, IN

02/1998-08/2002

Full-time practice

The Frame Nursing Facility

Indianapolis, IN

02/2001-08/2002

Part-time consultant

University of Maryland Counseling Center

College Park, MD

08/1991-08/1992

Doctoral Internship

Ball State University Community Clinic

Muncie, IN

09/1988-05/2001

Doctor Practicum

Veterans Administration

Boston, MA

09/1987-05/1988

Master's Internship

Scope of Practice:
- Individual, group and couples therapy
- Pyschodynamic and intergrative orientation
- Specialization in eating disorders, fertility issues, Dialouge Therapy
Client and/or Legal Guardian's Disclosure Confirmation
My signature acknowledges that I have been given the professional qualification and experience of Rachel Natvig, Ph.D., Psychotherapist, who is practicing under the clinical supervision of Paul Foxman, Ph.D. Information containing unprofessional conduct for this profession is posted in the common areas of our offices, along with information on making a consumer inquiry, or filing a complaint with the Vermont State Office of Professional Regulation. This information is also available through the Vermont Secretary of State’s offices, National Life Building, FL2, Montpelier, Vermont, 05602-3402. That office may also be reached by telephone (802) 828-1505, or through their website, www.vtprofessionals.org.
Client Name:

First NameLast Name
Client Signature:

Clear
Date:

MonthDayYear
Date
Legal Guardian (if applicable):

First NameLast Name
Legal Guardian Signature (if applicable):

Clear
Date:

MonthDayYear
Date
__________________________________________________________

Rachel Natvig, Ph.D. Date
Should be Empty:

Professional Disclosure Information