Professional Disclosure

Pursuant to (21 NCAC 53 .0204), Counselors in North Carolina are mandated to provide a Professional Disclosure Statement “to each client prior to the performance of clinical mental health counseling services. This requirement aligns with the American Counseling Association’s Code of Ethics (ACA, 2014) which requires counselors to “review in writing and verbally with clients the rights and responsibilities of both the counselor and the client” (A.2.a. Informed Consent). The ACA specifies that the informed consent must include the nature of all services provided, counselor credentials and relevant experience, fees, billing information, confidentiality, supervision arrangements, how records will be handled, and more. As with any informed consent, the goal is to ensure that both the client and the counselor understand the nature of the relationship and the types of services that can be expected.

Each licensure type (LCMHCA, LCMHC, and LCMHCS) has specific requirements regarding what needs to be included in their Professional Disclosure Statement:

Professional Disclosure Instructions

LCMHC Associate (LCMHCA) - Instructions for preparing your Professional Disclosure Statement
LCMHC - Instructions for preparing your Professional Disclosure Statement
LCMHC Supervisor (LCMHCS) - Instructions for preparing your Professional Disclosure Statement

Professional Disclosure Templates

LCMHCA PDS Template
LCMHC PDS Template
LCMHCS PDS Template

Disclaimer: All information provided by the North Carolina Board of Licensed Clinical Mental Health Counselors (hereafter “the Board”) on this web site is made available to provide immediate access for the convenience of interested persons. While the Board believes the information to be reliable, human or mechanical error remains a possibility, as does delay in the posting or updating of information. Therefore, the Board makes no guarantee as to the accuracy, completeness, timeliness, currency, or for any errors or omissions, or for the use or results obtained from the use of this information. All access to and use of this web site is governed by the Disclaimers as set forth by the Board.