Consent and Confidentiality Agreement
I understand that all services delivered by Jamie Wiggins M.A. and Wild Rose Mysterium are offered for personal growth and development and are meant to spiritually challenge, uplift, and support. The services are not intended as individual or group psychotherapy. No clinical notes, treatment plans, or mental health diagnoses will be made.
The services delivered by Jamie Wiggins, M.A, Wild Rose Mysterium, and affiliates draw on many different practices and methods, some developed from her experience in her creative work, some formed by personal depth work and years of training in dream tending, womb wisdom, and some shaped by her work and Master’s Degree and work in Art Therapy Counseling. I understand, however, that the services offered do not involve the assessment, diagnosis, and/or treatment of mental, emotional or behavioral disorders as defined by the American Psychological Association and are not a substitute for psychiatric treatment and/or a substitute for a Medical Practitioner.
I understand and agree that I am fully responsible for my well-being and, subsequently, my decisions and choices before, during and after my in-person or group sessions and/or video meetings and/or calls.
Confidentiality
I understand that the information disclosed within the sessions will remain confidential and that Jamie Wiggins M.A. will maintain the confidentiality of our communications only to the extent defined by the laws of the states/countries in which each of us resides. I understand that mentors with whom Jamie Wiggins M.A. periodically seeks consultation may be provided with anonymous, non-referenced information and my confidentiality is fully maintained.
I understand that emails are not encrypted and because email messages are technically vulnerable to unauthorized access, Jamie Wiggins can not guarantee complete privacy. I understand that if I should choose to communicate with her between sessions via the computer, there is a possibility of compromised confidentiality. I understand that if client is a minor and information is disclosed that client or family member is at risk I am legally obligated to report this information.
Payments/Cancellations
I understand that once an agreement is reached for a regular scheduled time, those hours will be reserved for me and payment is due at the time of the session. I understand that a minimum of 48 hours is required for canceling or rescheduling an appointment and that unless a different agreement is reached, the cost of a full session will be charged for sessions missed without such notifications.
I understand that these services are not substitutes for psychiatric or medical care and offer no health warranties or guarantees of any kind. This includes recommendations or participation in any related activity such as dream work, creative work, meditation, rituals and visualizations. I agree on behalf of myself (and my personal representatives, heirs executors, administrators, agents and assigns), to the maximum extent permitted by applicable law, to release, waive, acquit and forever discharge Jamie Wiggins M.A. from every claim, suit, action, demand or right to compensation for damages I may claim to have. I have read the statements above and understand and agree with the points contained therein: