Consent For Observers

Please read through the following and complete the form as indicated.

Each person must provide their own electronic signature for consent.

Dallas Henslee, M.A., L.P.C., N.C.C

NCC-292942 exp. July 31, 2022

Colorado LPC-6075 exp. August 31, 2023

Mark Henslee, Pastoral Care

Our methods involve active listening and discussion, problem-solving, and directed activities with solution-focused methods. We provide spiritual counseling based in prayer, led by the Holy Spirit, in alignment with The Word of God (The Holy Bible). We teach and implement spiritual principles and weapons in the power and authority of Jesus Christ to provide emotional, spiritual, and mental freedom and healing.

From time to time, we request that a colleague or intern attend sessions for the purposes of observation and learning. When this happens, any person in the session is bound by the same professional confidentiality to which we adhere and agrees to our confidentiality statement as put forth in our Disclosures Statement.

Consent for Observers

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Acknowledgement

I understand that the following individual(s) will be in attendance at my sessions:

Consent
Consent
Name*
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Electronic Signature*
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