New client Under 18 Registration
Please read this information carefully; by submitting this registration form, you and your parent/guardian indicate your understanding and consent.
Coping After Suicide, LLC and Joanne L. Harpel, MPhil, CT, JD, President serve solely as a suicide bereavement advisor and not as a mental health professional. Participation in suicide bereavement support sessions can be quite emotionally distressing. Any advice or guidance that may be provided is not intended to constitute therapy or mental health counseling and shall not be so construed. Responsibility for seeking psychological counseling and/or medical advice rests solely with you (and/or your parent or guardian if you’re under 18). Coping After Suicide, LLC and Joanne L. Harpel, President are not governed by the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). By submitting this registration form you agree to release and hold harmless Coping After Suicide, LLC; its employees and agents; and Joanne L. Harpel, President from any and all liability that may arise out of your participation.
If at any time you’re in significant emotional distress, crisis, and/or feeling suicidal call the National Suicide Prevention Lifeline at 800-273-TALK, text “TALK” to the Crisis Text Line at 741-741, call 911, or go the nearest emergency room.
Sessions may be conducted in person, by telephone, and/or by video chat (travel time, if any, is charged at 50% of the session rate, plus out of pocket expenses). Sessions are payable in full immediately upon completion, at a rate that may be subject to periodic increases, by either: Zelle (to firstname.lastname@example.org), Venmo (to @Joanne-Harpel), PayPal (to http://paypal.me/JoanneHarpel), or credit card (a service charge is added to all PayPal and credit card payments).
If you have to cancel, please do so at least 24 hours in advance. Late cancellations and no-shows are subject to a cancellation charge of up to the full session fee.