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Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

New clients, please complete these questions to the best of your ability and complete the Counseling Intake Form before our first session. I look forward to seeing you soon!

Client Information

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Terms and Policy

Informed Consent

Counseling is a cooperative venture with responsibility resting on both the counselor and the client. In order to enable you and Lauren to work most effectively together, please carefully read the information below. If you have any questions, Lauren will be happy to discuss them with you.


Lauren Dack is a Master's level counselor who is a Licensed Marriage and Family Therapist and a Licensed Professional Counselor approved by the Georgia Board of Professional Counselors, Social Workers and Marriage and Family Therapists. Lauren has been working with men, women, couples, and families in the State of Georgia for 9 years.


Confidentiality: The Health Insurance Portability and Accountability Act (HIPPA) has created new patient protections surrounding the use of protected health information. Commonly referred to as the "medical records privacy law," HIPPA provides patient protections related to the electronic transmission of data, the keeping and use of patient records, and storage and access to health care records. HIPPAA applies to all heath care providers, including mental heath care, and providers and health care agencies throughout the country are now required to provide patients a notification of their privacy rights as it relates to their heath care records. An explanation of those rights is attached to this document.

Communications between client and counselor are confidential and will not be revealed unless required by law such as in situations of:

1.) child abuse, elder abuse, or threats of physical harm to self or others,

2.) for clinical supervision purposes,

3.) if subpoenaed by a court of law,

4). If a guardian ad litem (GAL) is appointed in a custody case involving adolescent clients I have seen for counseling services and she/he is ordered by the court to have access to mental health practitioners and records therein, I am required to provide that information as it is court ordered.

5.) The Patriot Act of 2001 requires me in certain circumstances, to provide federal law agents with records, papers and documents upon request and prohibits me from disclosing to my client that the FBI sought or obtained the items under the Act.

6.) I am happy to provide paperwork for you to file with your insurance company; however, in doing so, there will be a diagnosis required with the paperwork and there may be a violation of your confidentiality, as insurance companies do not always observe the same strict confidentiality polices that I do as a Licensed Associate Professional Counselor. I am also willing to share information about our counseling sessions with any other professional or agency that you wish, provided you sign a Release-of-information form.

7.) In working with adolescents, though legally the parent(s) or legal guardian(s) of adolescent clients are the client and confidentiality lies with the client, in order to establish and preserve the essential relationship and setting for a adolescent's therapy, I honor what the adolescent does or says in our sessions as confidential while providing parents and/or legal guardians summaries of treatment goals, plan and progress as well as recommendations.

8.) In working with couples and families, the couple as an entity, and the family as an entity, is my client.  I am not providing individual therapy for either half of the couple or for any one member of the family although sessions with individuals in the couple/family may be a part of the couples/family therapy. I will not be a "secret keeper" nor will I facilitate secret keeping. If anything significant is revealed in an individual session that I feel the other party needs to be told, I will require it be brought up in a session together so we can work through it. If I we are unable to bring the secret to light, we will have to terminate the therapeutic relationship, and I will refer you to another therapist.


Counseling Fees: The fee for a 50 minute session is $130. For couples, the initial 50 minute intake session cost $150 due to the amount of time outside the session counselor will spend analyzing the assessments given after the 1st session. After that, 50 minute sessions are $130. We ask that you keep your account current and pay by cash, check or credit card (make checks out to Lauren Dack Counseling, LLC) at the beginning of the session. We do not accept insurance, but are happy to provide you with a receipt at the end of the month if you wish to file your own insurance claim. If you are experiencing financial hardship, please speak to your counselor about this, so she can work with you. In the event of lack of payments received for over 2 sessions, no further sessions will be made until the balance is paid in full.


Cancellation of Appointments: If you must cancel your appointment for any reason, please call or email Lauren at 404.913.1102 or at least 48 business hours in advance in order to avoid the session fee charge, however please inform me as soon as possible when you're able. If you miss your appointment, you will be billed at the full rate. Our session is very important to me, as are you. I plan my day around our scheduled appointment, so please be considerate.


Late Appointments: Each appointment begins at the scheduled time and lasts for 50 minutes. If you should arrive late for an appointment, the appointment will begin shortly after your arrival and end at the normal time.


Telephone Calls/Emails: The purpose of email, telephone, or other electronic correspondence is to assist in our communication regarding scheduling, appointment information, homework assignments, and information regarding payment status. This type of communication is not a way to communicate therapeutic information regarding your counseling care and treatment as these matters are saved for your counseling session time. While I will take reasonable, precautions to protect your confidential information, as with any electronic communication, there is no way to completely secure communication. Should you need to contact Lauren, you may leave a message at 404.913.1102 Please leave your name, telephone number, and a brief message. Your call will be returned as soon as possible, usually within 24 business hours.


Public Contact: In the event that you see me outside of the counseling office, my policy is to not acknowledge you until or unless you respond first. If you would like to acknowledge me or not, I will not be offended as it is completely dependent upon your level of comfort and desire for discretion.

Nature of Counseling: You have the right to choose alternatives and to participate in designing your treatment plan. The therapeutic relationship, which we establish, will be characterized by respect and cooperation. Through therapeutic techniques and methods, I will offer you ways in which you can reach your counseling goals and objectives. My services will be practiced in a professional manner that is consistent with the Georgia State Board of Examiners of Marriage and Family Therapists qualifications for ethical standards. You are entitled to an explanation of your condition and the treatment that will be provided as well as the probable duration and adverse risk involved. Please know that it is impossible to guarantee any specific results regarding your counseling goals for the counseling process, however, together we can work to achieve the best possible results for you.


Emergency Procedures: This practice is not staffed with a receptionist or paging system, therefore we are not equipped to handle emergency situations. In the case of an emergency, we recommend you contact either a hospital emergency room or the police depending on the situation. You can also call the Georgia Crisis Line at: (800) 715-4225 or the crisis text line 741-741.


Divorce/Custody Disputes:If you become involved in a divorce or custody dispute, I am not able to provide evaluations or expert testimony in court. You should hire a different mental professional for evaluations or testimony that you may require. My position is based on two reasons: 1) my statements will be seen as biased in your favor because we have a therapeutic relationship and 2) the testimony might affect our therapeutic relationship and I must put this relationship first. By signing this informed consent document, you are acknowledging your full understanding of and agreement on my position concerning this matter.

I, fully understand what I have just read and voluntarily request counseling services at Joyful Life Counseling and I agree to these terms and conditions.

( Type Full Name )
( Full Name )
Patient Notification of Privacy Rights

The Health Insurance Portability and Accountability Act (HIPAA) has created new patient protections surrounding the use of protected health information. Commonly referred to as the "medical records privacy law," HIPAA provides patient protections related to the electronic transmission of data ("the transaction rules"), the keeping and use of patient records ("privacy rules"), and storage and access to health care records ("security rules"). HIPAA applies to all heath care providers, including mental health care, and providers and health care agencies thought the country are now required to provide patients a notification of their privacy rights as it relates to their health care records. You may have already received similar notices such as this one from your other health care providers.

As you might expect, the HIPAA law and regulations are extremely detailed and difficult to grasp if you don't have formal legal training. This Patient Notification of Privacy Rights is our attempt to inform you of your rights in a simple yet comprehensive fashion. Please read this document, as it is important you know what patient protections HIPAA affords all of us. In mental health care, confidentiality and privacy are central to the success of therapeutic relationship, and as such, you will find we make every effort to do all we can to protect the privacy of your mental health records. If you have any questions about any of the matters discussed in this document, please do not hesitate to ask for further clarification.

By law, {Simplified} Life Solutions is required to secure your signature indicating you have received a copy of the Patient Notification of Privacy Rights document.

I have received a copy of {Simplified} Life Solutions Patient Notification of Privacy Rights document, which provides a detailed description of the potential uses and disclosures of my protected health information, as well as my rights on these matters. I understand that I have the right to review this document and I may at any time, not or later, as any questions about or seek clarification of the matters discussed in this document. Signing below indicates only that I have received a copy of the Patient Notification of Privacy Rights document.

( Type Full Name )
( Full Name )
Financial Policy

You'll be asked to enter in a card in our secure portal in order to schedule. I will only charge your card if you do not cancel or change your appointment within 48 business hours. I will contact you after a missed appointment to ensure that there wasn't an emergency before charging your card. I will charge your card after our session only if that is the form of payment you choose. I also accept cash and check. 

To summarize, I'm ensuring you that your card is safe and I will not charge your card without you knowing about it. Thank you!

( Type Full Name )
( Full Name )