Consent for Service and Youth and Family Rights

1. My signature below indicates consent, which allows my minor child to receive services from Project Oz staff onsite and in community-based settings including but not limited to schools, community centers, and other establishments necessary for the delivery of services.
2. I understand this consent is effective for 1-year and can be revoked at any time by the minor or legal guardian.
3. We provide services to all youth and their families and do not discriminate in any way on the basis of race, sexual orientation, gender identity, gender expression, national origin, religion, ancestry, age, economic condition, health status, or disability.
4. Individual counseling/family therapy is voluntary. Every youth and family member has the right to refuse or discontinue services at any time. If you have been court-ordered or referred by probation, counseling is still voluntary. However, information on non-participation and non-attendance may be subject to disclosure to courts/probation officers.
5. Youth and their families have the right to participate — and are strongly encouraged to do so — in the process of developing family/youth goals. Family participation and input is important to the counseling process.
6. Youth and their families have the right to confidentiality. A release of information form must be signed by both the youth and the legal guardian in order to obtain or release information concerning current or past medical, psychiatric, or addiction treatment. Under no circumstances will client names be made available to outside agencies or individuals without a signed release of information.
7. All youth and their families are encouraged to express opinions and recommendations regarding the treatment process. Any grievance will be handled promptly.
8. If you feel that you have been treated unfairly, unprofessionally, or feel that your rights have been breached, you have the right to discuss the concern with any Project Oz Supervisor, Director, or the CEO.

CONFIDENTIALITY

Federal law and professional ethics require everything discussed in counseling stay in the strictest confidence. Therefore, Project Oz staff will not provide information to anyone without written permission. There are very few instances when Project Oz staff is required by law to disclose information. These situations include serious threats of homicide, suicide, and allegations of physical abuse, sexual abuse, or neglect of a minor. In rare circumstances, Project Oz could be called upon (subpoenaed) to testify in a court of law about you. If the law required Project Oz to do this, we would attempt to discuss any testimony with you beforehand.