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Professional Disclosure Statement


 I am a Licensed Professional Counselor 

Nature of Counseling

 My approach to the counseling involves family therapy and cognitive behavioral therapy in which I believe that each person are individuals within the family unit, but add their unique gifts to enhance the family as a whole.  Each person has a set of beliefs that inform their thoughts, emotions and actions.  Each thought, emotion and action impact the family in negative or positive ways in which affect the whole family system.  My role in that process is to help you realize your potential as you navigate through life's challenges and discover your own unique qualities and gifts that can be utilized for self and those around you.  My goal is to provide a safe and open environment where you can feel empowered to make decisions necessary for your life.

Effects of Counseling 

At any time, you may initiate with me a discussion of possible positive or negative effects of entering or not entering into, continuing, or discontinuing counseling.  I expect you to benefit from counseling; however, I cannot guarantee any specific results.  Counseling is a personal exploration that may lead to major changes in your life perspectives and decisions.  These changes may affect significant relationships, your career, and/or your understanding of yourself.  You may feel troubled, usually only temporarily, by some of the things you learn about yourself or some of the changes you may decide to make.  In addition, counseling can, at times, result in long lasting effects.  Although the exact nature of changes resulting from counseling cannot be predicted, I intend to work with you to achieve the best possible results for you. 

Some clients achieve their goals in only a few counseling sessions; whereas,  others may require months or even years of counseling.  As a client, you are in complete control and may end our counseling relationship at any time.  If you choose to end the counseling relationship, I ask that you participate in a termination session.  You also have the right to refuse or discuss modification of any of my counseling techniques or suggestions that you believe might be harmful.  I render counseling services in a professional manner consistent with accepted ethical standards.  If at any time for any reason, your are dissatisfied with my services, please let me know.

Appointments, Cancellation, and Crises

  In the event that you are unable to keep an appointment, please notify me at least 24 hours in advance, otherwise you will be charged the full fee for the session.  If the event is an emergency, and you are unable to contact me in advance, please notify me as soon as possible to avoid a fee being charged.  Likewise, if  you intend to discontinue counseling, please inform me.  You may contact me at 469-252-7090 or


If you are in a life-threatening emergency or feel that you may harm yourself or someone else, please call 911, the MHMR Crisis Line (800-762-0157), or have a trusted person bring you to your nearest ER.  I do not provide emergency services; however, we may be able to arrange additional sessions following the emergency.


Discussions between you and me, and even the fact that you are in counseling with me are confidential.  For this reason, if I see you in public, I will protect your confidentiality by greeting you only, if you greet me first.  I will also keep a written record of our sessions which is also confidential.  There are limits to confidentiality at which point I would be required to break confidentiality.  Those instances include: disclosure of self-harm, harm to others, a judge subpoena for records, disclosures of child abuse or elder abuse.  Files are closed once the counseling relationship ends and will remain confidential.   

Session Fees

  • Individual Session   50 minutes   $100
  • Family Session         70 minutes   $115

  • Group Therapy         90 minutes   $15                                                                                                                    

       Payment is due at time of service.  All checks and payments should be made to Jan Wares, LPC.  

If you have concerns with my performance as a counselor, you may contact the Texas State Board of Examiners of Professional Counselors at 512-834-6658, Licence Number 76652.  

I consent to receive treatment from Jan Wares, M. A., LPC, NCC for myself and/or my child.  I acknowledge that I have received a copy of the Personal Disclosure Statement.  

_____________________________________                                                    ______                   

Signature                                                                                                            Date

Jan Wares, M.A., LPC, NCC 

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