Informed Consent for Online/Telephone Services

I attest that I am at least 18 years of age.

I understand, that online/telephone services are not appropriate for addressing major crisis, severe mental health issues, suicidal, homicidal or violent behavior (past or present).

If you are considering suicide, or believe yourself to be a potential safety threat to others, you must immedicately call 9-1-1 and/or seek emergency care at your local hospital.

If at any time, it is determined that your needs are greater than the scope of practice or area(s) of expertise of our coaches/counselors and/or the client is unsuitable for online counseling services, S4YS reserves the right to refuse and/or end treatment and appropriate referral sources will be provided.

According to national licensure requirements, our professional staff is permitted to provide services in all states excluding: Arkansas and Nebraska which are geographical boundaries for distance counseling and require practitioners to be licensed by that state. If you resided in Arkansas or Nebraska and you choose to engage in services with S4YS, you understand and acknowledge that you will not be receiving state-licensed services. In addition, our services are not open to those living in a country that is prohibited by law, regulation, treaty, or administrative act from entering into trade relations with the United States.

You understand that there are no guarantees of what you will experience, and that you enter this Agreement and use the services of S4YS at your own risk. You understand the possible limitations and shall not hold S4YS and/or its associates legally liable for any information or insight distributed.

The Agreement shall be interpreted only in accordance with the laws of the State of Florida (excluding any rules governing choice of laws), and any legal proceeding associated with this Agreement will occur exclusively in the courts located in Broward County Florida.

* I have read, understood and agree to the Agreement and hereby give my consent to participate in the services rendered by S4YS.