Declaration and Client Rights

Declaration of Practices and Procedure

Carol Burnett-Williams

Counseling Beyond Walls, Owner

127 Terra Belle Blvd., Ste. 1, Covington, LA 70433

Qualifications :

I earned a Master's of Science in Counseling Psychology from William Carey University in 2008. I was previously licensed in the State of Mississippi as Licensed Professional Counselor #1698 with Mississippi LPC Board of Examiners, P. 0. Box 1668, Jackson, MS 39215 Office: 601-359 1010,Fax: 601-359-1030. I am also licensed as a Licensed Professional Counselor with Louisiana LPC Board of Examiners, #5610, 8631Summa Avenue, Baton Rouge, LA 70809, and


Counseling Relationship:

I see counseling as a strength based approach and process in which you the client, and I, the Counselor having come to understand, build a rapport, and trust for one another, which will allow us to work as a team. I also strive for client and counselor to have an honest relationship to foster change and growth for you. We will work together to explore and define present problem situations, develop future goals to improve your quality of life and work in a systematic approach toward realizing your goal.

Areas of Focus :

I focus on adult, children, and family issues. I am licensed as a National Board Certified Counselor from the National Board of Certified Counseling, #328320 from NBCC, PO Box 77699, Greensboro, North Carolina 27417-7699 USA, and (336) 547-0607.

Fees and Office Procedures:

Payment and fees will be billed based on services offered and agency will provide more information based on member's needs. Member can make payments or be billed for services rendered . Payment is accepted from insurance companies and we do provide services on a sliding scale based on clients financial circumstances. Appointments are typically set at the close of each session. I have available morning, afternoon, and evening appointments available Monday through Saturday. Appointments may be scheduled, rescheduled, or cancelled through the Carol Burnett - Williams at anytime via confidential email and/or text.

Services Offered and Clients Served:

I approach counseling from a cognitive-behavioral perspective which is based on the principle change your cognitions thus will led to a change in your behavior therefore improving your quality of life. I have experience working with children and families in a variety of formats and settings with a client centered approach and solution orientated. I have conducted groups and I primarily worked with children and adults of all ages. I have acted as a consultant and referral to children under the age 4. I have experience working with adults providing individual counseling services and completing assessments.

Code of Conduct:

As a counselor, I am required by law to adhere to the Code of Conduct for practice that has been adopted by my licensing board. A copy of the Code of Conduct is available to you upon request.

Privileged Communication :

Material revealed in counseling will remain strictly confidential except under the following circumstances, in accordance with the State law:

  1. The client signs a written release of info rm ati on indicating informed consent such release.
  2. The client expresses intent to harm himself/herself or someone else.
  3. There is a reasonable suspicion of abuse/neglect against a minor child, elderly, person (60 or older), or dependent adult.
  4. A court order is received directly the disclosure of information.

It is my policy to assert privileged communication on behalf of the client and the right to consult with the client if at all possible, except during an emergency, before mandated disclosure, I will endeavor to approve client to apprise clients of all mandated disclosures as conceivable.

In the event of marriage or family counseling, material obtained from an adult client individually may be shared with the client's spouse or other family members with the client's written permission. Any material obtained from a minor client may be shared with the client's parent or guardian.

Emergency Situations:

When personnel are unavailable to answer calls during regular office hours, you may leave a message on the answering machine, you may also leave a message with the receptionist because the line is secure and I will return your call as soon as possible. In an emergency situation when an immediate response is necessary, you may call 1-800-437-0303.

This is the phone number for after hours care utilizes this number after 5:00 pm and weekends and holidays. You may seek through emergency facilities or by calling 911.

Client Responsibilities' :

You, the client are a full partner in counseling. Your honesty and effort are essential to success. As we work together, if you have suggestions or concerns about your counseling, I expect you to share these with me so that we can make the necessary adjustment s. If determine that you would be better served by another mental health provider, I will help you with the referral process. If you are currently receiving services from another mental health professional, I expect you to inform me of this and grant me permission to share info rm ati on with this professional so that we may coordinate services to you.

Physical Health:

Physical health is an important factor in the emotional well-being of an individual. If you have not had a physical examination in the last year, it is recommended that you do so. Also, please provide me with a list of any medications that you are currently taking.

Potential Counseling Risk :

The client should be aware that counseling poses potential risks. In the course of working together, additional problems may surface of which you were not initially aware. If this occurs, you should feel free to share these concerns with me.

I have read the Declaration of Practice and Procedures of Carol Burnett-Williams, M.S., L.P.C., and my signature below indicates my fully informed consent to services provided by Carol Burnett-Williams., M.S., L.P.C.

Client Signature                                                                                                           Date

Carol Burnett-Williams, M. S., LPC                                                                           Date

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