Nancy Schornack, LMHC, CDWF - C Informed Consent

Professional Information:  I am a Licensed Mental Health Counselor in the State of Iowa, and hold a B.A. degree in Psychology and a M.A. degree in Biblical Counseling, both from regionally accredited institutions.  I have over 30 years of experience in counseling working with children, teens, adults, and couples.  I draw from a variety of theories, all of which I find to be biblically sound in order to take into account your spiritual, psychological, social, and biological dimensions.

Counseling Relationship:  I believe counseling is a process whereby you are seeking to resolve interpersonal, emotional, and/or spiritual difficulties with the assistance of a caring professional.  As your counselor I will bring to the sessions my professional knowledge and experience, but the ultimate responsibility for growth and change rests with you.  Therapy can last from a few weeks to several months.  We will be in ongoing dialogue about your needs, progress, and recommended duration of therapy. You are invited at any time to ask questions about my methods or the direction of your counseling.  If for any reason you are dissatisfied with my services, please let me know and I will try to resolve your concerns.  If we are unable to resolve your concerns, I will be available to assist you in finding qualified help elsewhere.  Occasionally, I may elect to discontinue therapy if I find factors interfereing with my ability to help you that we are unable to resolve.  

Side Effects of Counseling:  You should know that counseling is not always easy.  You may find yourself discussing very personal information, and you may find these conversations difficult.   I may suggest changes for you that at first may make you feel awkward or uncomfortable.  As you learn more about yourself, you may encounter changes, some pleasant and some unpleasant in your relationships with family members, friends, co-workers, etc. 

Counseling can be a disruptive process as you seek to create the change in your life that you desire, and it is possible that you may at times become depressed, anxious, agitated, or feel some other emotional/physical discomfort as you proceed through this process.  You will always be free to move at your own pace, and talk with me about any of these kinds of things that you may experience.  It is also important for you to understand that I cannot offer any promise about the results you will experience.  Your outcome will depend upon many thingsā€¦some that are beyond my control.

If at any time I believe that your situation requires knowledge that I do not have, I may refer you for a consultation with someone with specific training or experience in that given area.  I will discuss any such referral with you before we act. 

Confidentiality:  Under normal circumstances everything you discuss with me will be held in strict confidence.  However, you should be aware that there are some exceptions in which I may be required to report information to proper authorities and/or an appropriate family member or friend without your permission.  If I believe there is a risk that you might harm yourself or someone else, I will be required to contact the authorities, a family member or friend, or the person being threatened to give them the opportunity to protect you and/or him/herself.  I am also mandated by the state of Iowa (State Law, Code Section 232 & 235) to report suspected incidents of child and/or dependent adult abuse. If you become involved in any legal issues in which your mental health is an issue (for example child custody disputes or an injury lawsuit resulting in emotional pain/suffering) then the courts may insist upon, and obtain your counseling information from me.

If you are utilizing third party payment, then your insurance company will need access to certain information, including (but not always limited to) your diagnosis and dates of your visits.  I will use my best judgment in both discussing these circumstances with you if they arise, and in disclosing only essential information when required. 

I do utilize the services of an administrative assistant to help with general bookkeeping.  This individual has signed a confidentiality agreement and will have access to your name,billing, and insurance information.  They do not have access to any of the confidential counseling notes that I keep.

Finally, you should also know that I consult with other professionals as needed regarding clients with whom I am working.  This allows me to gain other perspectives and ideas as how to best help you reach your goals.  Such consultations are obtained in a way that your complete confidentiality is maintained.

Sessions, Fees, & Cancellations:  Counseling sessions normally last 50 minutes.  To best utilize your time, please come prepared with your ideas about how you can best use each session to your fullest benefit, and please share the responsibility with me in watching the clock so that we can bring each session to good closure in a timely manner. The initial assessment session(s) fee is $157, and all sessions following are $153. For those not utilizing insurance, fees may be adjusted based on financial hardship.  It is expected you pay the fee at each session.  If you have insurance coverage your co-pay is due at the time of your visit.  If there is a problem collecting payment from your insurance companyyou are personally responsible for payment of any remaining balance.  If you need to cancel an appointment you must notify me within 24 hours of that appointment.  Please call my office at 515-727-1667 to leave a message of your cancelation, or send me an e-mail at  I have reserved your appointment expressly for you; failure to notify me within 24 hours will result in you being charged $50 for the missed appointment.  I do understand that occasionaly emergencies do arise.  If this is the case please contact me as soon as possible to inform me of the reason for the lack of 24 hour notice to discuss your situation.

Appointments & Emergencies:  Appointments can be made following each session, or you may scheulde appointments online at the link provided on my website:  You may also contact me via e-mail at or call me at 515-727-1667 to schedule, however online scheduing is preferrable, and most efficient.   If you call or e-mail, I will do my best to follow up within 2 working business days. I do not work routinely on Fridays, so  e-mails or messages left on Thursday afternoons or Fridays will not be returned until the following Monday.  If you have not heard back from me after a reasonable amount of time, please try again as your message may have somehow been missed. 

If an urgent, but non-emergency need arises in between your sessions, you are welcome to notify me to request if you can obtain an appoitnment sooner then scheduled.  

If you have an emergency, promptly contact 911, your local emergency room, or crisis center. You can receive immediate support thru a national crisis text line by texting "HOME" to 741741.You can also call the NAMI Help Line at 1-800-950-6264 or you can also access a variety of crisis care services at

Electronic Communications:  You are welcome to communicate with me via e-mail or text regarding scheduling and other administrative concerns.  It is important to be aware that any electronic communication can be vulnerable to unauthorized access, and I cannot guarantee the confidentiality of any electronic communication.  Like phone messages, if your electronic communication is not responded to in a reasonable amount of time, please follow up with a phone call to ensure that your communication was received.

Dual Relationships and Socia Media:  Dual relationships can impair the therapeutic process.  For this reason I will not accept any invitations via social networking sites such as Facebook, Twitter, Linkedin or Pinterest, nor will I respond to blogs written by clients.

Recording Policy:  No sessions may be recorded without written permission by Nancy Schornack, and all members of that session.

Weapons Policy:  No weapons of any sort are allowed on th premises of my counseling office, or Regus Office Building.

Your signature indicates that you understand and agree to the above information and policies, and that any questions you have about this information has been answered to your satisfaction.

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