Welcome to Drew Null Counseling!
My goal is to assist you in achieving solutions to your problems and experience healthy, satisfying relationships that
will add meaning and purpose to your life. It has been shown that more favorable results are achieved in therapy
when clients have a good understanding of the therapy process. Please read the following information very carefully
so you may be able to make an informed consent to the counseling process. Please ask regarding any questions you
may have.
Therapist
My name is Andrew (Drew) Null, MS, LPC - Intern, a Licensed Professional Counselor Intern in the State of Texas,
doing business as Drew Null Counseling. I provide mental health care services to clients in conjunction with Fully
Living Counseling Services. I earned my Masters degree in Clinical Mental Health Counseling at the University of North
Texas in Denton, TX. I am a member of the American Counseling Association (ACA). Being that I am an LPC – Intern I
practice therapy under the supervision of LPC-S, Licensed Professional Counselor Supervisor, Tammy Weppleman,
and she may be contacted at (940) 594-1015 or [email protected].
Benefits and Risks of Therapy
Counseling is both an art and a science. Many individuals show great benefit from counseling, although results cannot
be guaranteed. People come into therapy with various problems that cause internal distress and relational issues.
Often, growth may not occur until you experience and confront uncomfortable issues that may lead you to feel
sadness, sorrow, anxiety, or pain. Sometimes changes made during the therapy process effect other relationships such
as family, friends or in the workplace. The success of the therapeutic relationship between you and your therapist
depends on the quality of mutual efforts.
Client involvement- Much of the success in achieving goals in therapy relies on you to take responsibility for certain
things. Keeping all scheduled appointments and being on time is very important. Being open, honest and active in
sessions is essential also. Additional effort in-between sessions such as completing assignments and thinking through
or being aware of thoughts and behaviors will also affect results. Please realize you are responsible for lifestyle
choices/changes that may result from therapy.
Counselor involvement- An initial assessment at the first session will be conducted, along with an ongoing
assessment of the nature of your concerns and problems. A therapy plan including goals and the processes for
achieving them will be developed and discussed with you.
Treatment
Throughout the course of therapy I may use various, research proven techniques to provide you with the most
effective treatment possible. My foundational guiding theory is Reality or Choice theory. This theory focuses on the
choices that we as individuals make that create the person, life, and situations we find ourselves in. Through the
course of treatment we will work through your desires in life situations and the choices you are making to achieve
your goals. In Reality or Choice theory we will work through whether or not you feel that your choices are helping you
achieve your goals and help to plan, possible more effective choices. This is the foundation from which I work but this
is not the only theoretical framework from which therapeutic interventions may be garnered from.
Alternative Treatment- There is a variety of other services available to you that work in conjunction with, or in
place of counseling. I can assist you in determining the applicability to alternative treatments.
Length of Therapy- The number of sessions depends on many factors and will be assessed and discussed with you.
Therapy sessions are 45-50 minutes in length. Therapy will be terminated when goals have been achieved and by
mutual consent. An exit session, or termination interview will be conducted at the end of therapy. You have the right
to terminate therapy at any time.
Testing- Sometimes in order to better understand issues or to assist in treatment, psychological tests may be utilized.
The purpose of these tests will be discussed in advance and results shared with you. Fees for testing are separate from
regular sessions.
Consumer Information- An individual who wishes to file a complaint against a Licensed Professional Counselor
may write to: Complaints Management and Investigative Section; P.O. Box 141369; Austin, Texas 78714-1369; or call
1-800- 942-5540 to request the appropriate form or obtain more information. File Retention- In the event this
counseling practice terminates, your records will be retained in conjunction with professional and ethical standards.
Confidentiality Initial ________________
Discussions between a therapist and a client are confidential. No information will be released without the client’s
written consent unless mandated by law. It is the goal of the therapist to protect the confidentiality of your records;
however, there are exceptions to confidentiality when limited according to legal requirements or specific consent.
Exceptions to Confidentiality- Exceptions to confidentiality are prescribed by the Licensing board in the State of
Texas and include, but are not limited to, the following situations: 1) abuse or neglect of minors; abuse, neglect, or
exploitation of the elderly; 2) a therapist’s duty to warn due to danger, physically or emotionally to the client,
therapist or another person; 3) a subpoena or court order; 4) fee disputes between the therapist and the client; or 5)
the filing of a complaint with the licensing board. Sessions may be recorded with proper notice to you. Please take
note that you are welcome to email me. But email is not considered confidential and I cannot completely safeguard
your confidentiality.
Payment for Services Initial ________________
Payment is expected at the time services are rendered, after each session. The standard fee for an individual or couple
is $70 per session. We accept cash, checks and Visa/MC. Fees incurred for returned checks are the client’s full
responsibility. Please discuss any payment problems with me. Fees for testing are separate from, and additional to
session fees. In the event of legal proceedings, preparation of any documentation will billed at a rate of $150 per hour
along with testimony or appearances plus all additional expenses (responding to subpoenas, depositions, drive time
etc). Standard fees are subject to change with a minimum 30 day notice.
Cancellations / Missed Appointments
Appointments canceled with 24 hour notice incur no fees and every effort will be made to reschedule in a timely
manner. If you are unable to keep a scheduled appointment, please contact the office at (940) 387-6350 at least 24
hours in advance. Appointments missed or canceled with less than 24 hour notice will be charged at full fee. I
understand that emergencies and health problems do come up and I am willing to consider them when adequate
notice is not given. However, No-shows, last minute scheduling conflicts with other professionals, sports events,
family events, generally will not be considered. Please note that the provider may terminate the counseling
relationship after 3 missed appointments without calling to cancel 24 hours prior to your scheduled appointment.
Please be aware and understand that failure to call 24 hours in advance for cancellation of an appointment will result
in you being billed the full charge for that appointment. Call (940) 387-6350.
Electronic Communication
When I am available, I will respond to email communication. However, I cannot ensure confidentiality of any
correspondence sent via email and cannot be responsible for breaches in confidentiality resulting from someone
getting your password or having access to your account. Additionally, all email correspondence between us will be
printed and placed in your file. My email is [email protected]. I will attempt to try to respond to
emails within 24 hours.
Emergencies
Emergencies are urgent issues requiring immediate action. If there is a life-threatening emergency, go to the
Emergency Room or call 911. I can be reached by calling (940) 387-6350 and will respond as quickly as possible.
Incapacitation/death
I acknowledge that, in the event the undersigned therapist become incapacitated or dies, it will become necessary for
another therapist to take possession of my file and records. By signing this information and consent form, I give my
consent to allowing a licensed mental health professional selected by the undersigned therapist to take possession of
my file and records and provide me with copies upon request or to deliver them to a therapist of my choice.
Consent to Treatment
1. I agree to enter into therapy with Andrew Null, MS, LPC-Intern. I have received advisement in regards to
therapeutic fees and I agree to pay for services rendered with payment due at the conclusion of each session and
no balance will be carried. I understand that if I am late to a session, the length of that session may be shortened,
and I agree to pay for a full session.
2. I understand that I can leave therapy at any time and I have no moral, legal, or financial obligation to complete
the maximum number of sessions listed in this contract; I am contracting only to pay for completed therapy
sessions.
3. A 24 hour notice is required for cancellation of a scheduled session. If I do not meet this requirement, I agree to
pay the $70.00 No-Show Fee. I understand that this will be my responsibility.
4. If I miss an appointment without prior notice and do not contact this office with 10 business days following the
missed appointment, then I understand my therapy will have terminated.
5. I understand that the therapist has the right to see legal recourse to recoup any unpaid balance. In pursuing these
measures, the therapist has the right to use confidential information to establish the fee claim.
Signed:____________________________________ Date:_____________________
Signed:____________________________________ Date:_____________________
Therapist:_________________________________ Date:_____________________
IF A CLIENT IS A MINOR: I give permission for this minor child(ren) to receive counseling without a parent or
guardian present. I have the legal authority to seek and grant permission for professional services for a minor child,
there being no legal decree disallowing my authority to assume such responsibility.
Name of Child:________________________________DOB:______________________
Name of Child:________________________________DOB:______________________
Name of Child:________________________________DOB:______________________
Name of Parent or Legal Guardian:__________________________________________
Signed:____________________________________ Date:_____________________
Therapist:__________________________________ Date:_____________________
Credit Card Information
Please provide your credit card information if you plan use to make payments on your account or for no-shows and
missed appointments without giving prior notice:
Type of Credit Card (circle): Visa/ Master Card
Name as printed on card: ________________________________________
Credit Card Number: ____________________________________________
Expiration Date: ___________________________
3-4 Digit Security Code on Back of Card: ______________________
Billing address for credit card: ______________________________________________________________
__________________City ____________State
__________________Zip Code
By my signature below, I grant Andrew L. Null my permission to charge the account described above.
Signature Date: _________________________________________________
Printed Name: __________________________________________________
By my signature below, I grant Andrew L. Null permission to charge the account described above for any outstanding
balance that is 60 days past due.
Signature/Date: __________________________________________________
All information disclosed on this form will be held in accordance with Federal Confidentiality Standards