Schedule a Consultation with Bernard

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Acknowledgement of non-treatment and consent for initial consultation Acknowledgement of non-treatment and consent for initial consultation

By marking each acknowledgment below, I agree to the following: By marking each acknowledgment below, I agree to the following: I have read and understood the above Disclosure Statement Consultations are not intended for those experiencing an acute physical or mental health crisis. If I am experiencing, or anyone under my care, is experiencing a crisis I should call 911 or my area's crisis line or visit on Emergency Department. I understand and agree that I am not, nor is anyone under my care, receiving health care services from Bernard Grant, which is not a "covered entity” under the Health Insurance Portability and Accountability Act (HIPAA). I further understand that I will not have access to any records created by Bernard Grant as a result of this consultation. While the information I share during the course of a consultation with Bernard Grant is private, Bernard Grant is mandated by policy and in many cases, also by local laws, to report to local authorities any concerns about the abuse or neglect of a child or a vulnerable adult. If, during the course of a consultation, the Client discloses or gives reason to believe that they are experiencing, or anyone under their care is experiencing acute suicidal thoughts or intent, or homicidal thoughts or intent, Bernard Grant will take steps to contact emergency services to provide immediate assistance to the Client. This may require the disclosure of private Client information to emergency services and/or local authorities. For any additional services requested by the Client after this one-time consultation, Bernard Grant shall prepare a new Statement of Work, including specific goals, a defined process, expected timeline, and estimated service fees. The new Statement of Work will be presented back to the Client as part of a formal Client Agreement for review and signature prior to engaging Bernard Grant for further work. A deposit of 50% of the total lower-end estimated service fees will be invoiced and due upon receipt following the signing of the Client Agreement. Bernard Grant’s hourly rates are $375.00 per hour for any services provided beyond the initial consultation.

Upon submission you will be automatically redirected to my scheduler to pay and book your consultation. Upon submission you will be automatically redirected to my scheduler to pay and book your consultation.