Effective July 25th, 2023

1. Introduction:

The following informed consent is provided to acquaint you with the policies and procedures of our The Cairo Brown Foundation. The Terms of Service (“Terms”) contained herein govern the Client’s relationship with The Cairo Brown Foundation. Please read these Terms of Service carefully before using the Service. Access to, and use of the Service, is based on the Client’s acceptance of, and compliance with, these Terms. These Terms apply to all visitors, users and others who access or use the Service. By accessing or using the Service you agree to be bound by these Terms and accept all legal consequences.

2. Scope of Services:

The Cairo Brown Foundation provides individual counseling, group therapy, couples counseling, and family therapy. 

3. Qualifications and Credentials:

The counselor Shanet Brown is a M.S., LPC-A “supervised under Dr.Jeremy Berry, Ph.D, LPC-S, NCC”

4. Client-Counselor Relationship:

Your interaction with the counselor is intended to be both professional and therapeutic. It is crucial that the counselor not have any other kind of relationship with you to maintain this one. Relationships at the workplace or on the personal level reduce the therapeutic relationship's efficacy. Although your counselor wants to be there for you, he or she is unable to be your friend or develop a close personal bond with you. You should keep any gifts, bartering, or service exchanges between you and the therapist to yourself.

Important information on information relating to health: YOU USE THE SERVICES AT YOUR OWN RISK, AS DOES ANY INFORMATION AVAILABLE ON OR IN CONNECTION WITH THE SERVICES. THE SERVICES COULD CONTAIN CERTAIN HEALTH-RELATED INFORMATION. Such information (A) SHOULD NOT BE CONSTRUED AS THE PROVISION OF ADVICE OR RECOMMENDATIONS, (B) SHOULD NOT BE CONSTRUED AS THE PROVISION OF DIAGNOSIS OR TREATMENT, AND (C) SHOULD NOT BE RELIED UPON AS THE BASIS FOR ANY DECISION OR ACTION, INCLUDING WITHOUT LIMITATION THE DIAGNOSIS OR TREATMENT OF ANY HEALTH PROBLEM. The accuracy or dependability of any such information is not the responsibility of the organization. Such details are not exhaustive and shouldn't be taken as complete or current.

IT IS YOUR RESPONSIBILITY TO VERIFY ANY INFORMATION AVAILABLE THROUGH THE SERVICES FOR ACCURACY, COMPLETENESS, OR USEFULNESS. THE RELATIONSHIP BETWEEN YOU AND THE ORGANIZATION IS NOT A PHYSICIAN-PATIENT OR SIMILAR RELATIONSHIP; ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH PROVIDER WITH ANY QUESTIONS YOU MAY HAVE REGARDING A MEDICAL CONDITION, AND NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY IN SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ OR HEARD ON THE SERVICES. ASPECTS OF TESTS, DOCTORS, PRODUCTS, PROCEDURES, OPINIONS, OR OTHER INFORMATION THAT MAY BE MENTIONED ON THE SERVICES ARE NOT RECOMMENDED OR ENDORSE BY THE ORGANIZATION. RELIANCE ON ANY INFORMATION PROVIDED BY THE ORGANIZATION OR ITS EMPLOYEES, OR PERSONS PROVIDING INFORMATION IN CONNECTION WITH THE SERVICES AT THE ORGANIZATION'S INVITATION, OTHER VISITORS OR USERS OF THE SERVICES AND/OR ANY OTHER THIRD PARTY IS SOLELY AT YOUR OWN RISK.

5. Confidentiality:

In general, the law protects the privacy of all communication between a client and a mental health provider. I may only release information about your treatment to others if you sign a written authorization form. You may revoke any such authorizations at any time, which must be in writing. However, in the following situations, your authorization is not required to release your personal information: 

• Therapist’s duty to warn another in the case of potential suicide, homicide, or threat of imminent, serious harm to another individual.

 • Therapist’s duty to report suspicion of abuse or neglect of children or vulnerable adults. 

• Therapist’s duty to report prenatal exposure to cocaine, heroin, phencyclidine, methamphetamine, amphetamine or their derivatives, THC, and excesses and habitual use of alcohol. 

• Therapist’s duty to report the misconduct of mental health or health care professionals. 

• Therapist’s duty to provide a spouse or parent of a deceased client access to their child or spouse’s records. 

• Therapist’s duty to provide parents of minor children access to their child’s records. Minor clients can request, in writing, that information not be disclosed to parents. Such a request should be discussed with the therapist. 

• Therapist’s duty to release records if subpoenaed by the courts. 

• Therapist’s obligations to contracts (e.g. to employer of client, to an insurance carrier or health plan.)

5.1

Confidentiality will be maintained within the family if clients participate in family therapy or couples therapy (relational therapy). The client is regarded as the relationship unit. Your physician is unable to maintain confidentiality if doing so may jeopardize the therapeutic alliance. The therapist will assist the client in getting to a point where the material can be shared if they need to work through something before sharing it. It may be essential to terminate the client and resources may be made available if the person is unable to reveal the information. A smaller section of the relationship unit may be seen for one or more sessions independently throughout the course of our work together. You may think of these meetings as a component of the work we're doing together. If you participate in any of these sessions as an individual, please be aware that any material given there may need to be shared with the full relational unit.

Clients in couples/marriage counseling consent to refrain from ever seeking to subpoena evidence against one another in court.

6. Informed Consent:

Although I anticipate advantages from this therapy, I fully understand and acknowledge that such benefits and the intended results cannot be guaranteed due to circumstances outside of our control.

I am aware that going through counseling might trigger unpleasant emotions and behaviors including worry, despair, and rage. I am aware that this is a typical reaction to working through unresolved past traumas, and that my practitioner and I will work through these feelings.

7. Fees and Payment:

Unless otherwise agreed upon, you will be required to pay the whole amount at the start of each session. You can use PayPal or Venmo to use your debit/credit card, money order, or cash to pay. If/when more professional services are sought, payment schedules will be negotiated. No checks are accepted to avoid any return check fees. 

Sliding fees are available upon request. 

Fee for a 50-minute individual session - $75 

Fee for a 50- minute couple & family session- $125

Fee for a 50-minute virtual session (individual)- $60

Fee for a 50- minute virtual session (couple or family)- $110

8. Session Scheduling:

I set aside 50-minute slots. The cost will be divided by the agreed-upon appointment length if you want lengthier sessions. If you have contacted to let us know you would be late for an appointment, you may use the remaining time of our scheduled session. After 15 minutes from the scheduled start time, if you haven't called, I might not be accessible. If it is compatible with the established treatment plan, it may occasionally be appropriate to meet more frequently or less frequently than once per week.

9. Technology and Communication:

Virtual counseling is available via private non-recorded Zoom session or Psychology Today platform session. Fees are available at (thecairobrownfoundation.org). 

Communications made using a computer, email, text message, or a cell phone may be reasonably simple for unauthorized individuals to access, which compromises their privacy and confidentiality.

Because servers have limitless, direct access to all emails that pass through them, emails are susceptible to such unwanted access. Fax messages can be sent to the incorrect address and emails are not encrypted.

I will assume you have made an informed choice to communicate confidential or highly private information via email, text, or cell phone and will respect your decision to do so. I will view it as your agreement to take the risk that such communication may be intercepted. You acknowledge that your medical record includes electronic communications. You commit to avoiding using electronic communication during an emergency. Electronic communications could not be deliverable or timely as a result of network or computer issues.

Review our privacy policy here: https://www.thecairobrownfoundation.org/privacy-policy-1

10. Record Keeping and Data Protection:

22 Tex. Admin. Code § 801.48 A licensee must keep accurate records of therapeutic services, including dates of services, types of services, progress or case notes and billing information for a minimum of seven years after termination of services or five years after a client reaches the age of majority, whichever is greater.

The retention and keeping of treatment records for a period of seven years from the last point of contact is mandated by the regulations and standards of the therapy profession. Upon written request, you have the right to see and/or get a copy of your records, unless it is thought that doing so would be emotionally harmful in which case, they will be provided to a mental health expert of your choosing. These are professional documents, therefore persons who are not mental health specialists may misinterpret them or find them disturbing. The right to charge $.10 per page for copying expenses and $10 for administrative charges is reserved by The Cairo Brown Foundation. 

We regularly back up all sensitive data from PCs onto USBs and have firewalls, virus protection, and passwords installed on all our machines. The USBs are kept in a safe place. 

11. Termination of Services:

If the Cairo Brown Foundation  determines that you have violated or behaved inconsistently with the terms or spirit of this Agreement, it may, in its sole discretion, cancel your access to or use of the Services at any time and for any reason. Your right to use the Services shall immediately end upon any such termination. You acknowledge that the Cairo Brown Foundation may immediately deactivate or delete your password, user name, and all associated information and files, and/or restrict future access to such information or files, upon any termination of your access to or use of the Services, without prior notice to you.

12. Complaints and Grievances:

A “grievance” shall be defined as a dispute or controversy arising from the misapplication or misinterpretation of the specific and express written provisions of this Agreement.

We reserve the right to investigate complaints or reported violations of this Agreement and to take any action we deem appropriate, including, but not limited to, reporting any suspected unlawful activity to law enforcement officials, regulators, or other third parties and disclosing any information necessary or appropriate to such persons or entities relating to your profile, email addresses, usage history, posted materials, IP addresses, and traffic information.

12.1 

The other provisions of this Agreement will still be in full force and effect if any part of it is found to be unlawful or unenforceable and will be interpreted in accordance with existing law. This Agreement shall take precedence if any Content is in contradiction with or inconsistent with it. Any term of this Agreement that we fail to enforce will not be deemed to be waived, nor will it affect our ability to do so. In the event of termination, our rights under this Agreement remain in effect.

13. Legal Jurisdiction:

This Agreement will be treated as if it were executed and performed in Killeen, Texas, and will be governed by and construed in accordance with the laws of the state of Texas without regard to conflict of law provisions. In addition, you agree to submit to the personal jurisdiction and venue of such courts. Any cause of action by you with respect to our Website or Service must be instituted within one (1) year after the cause of action arose or be forever waived and barred.

14. Amendments to Terms and Conditions:

By providing you with prior notice of the changes through email or in writing, we retain the right to modify these Terms and Conditions at any time. These updates will be published on our website as well. Thirty days following the receipt of the notice, these modifications will take effect. For the avoidance of doubt, unless the parties expressly agree differently, no unilateral alteration will change, retroactively, any agreed dispute-resolution provisions of these Terms and Conditions, if any, including, for example, arbitration clauses for then-pending disputes. After we notify you of any changes to these Terms and Conditions, your continuing use of our website, services, and products will be deemed your acceptance of those changes. If the modifications to these Terms and Conditions are unacceptable to you, you can opt to discontinue the use of our Website, Services, and Products.

15. Governing Law:

The Cairo Brown Foundation is not intended to be subject to the laws or jurisdiction of any state, nation, or territory other than that of the United States through use of the Services, which are controlled, operated, and hosted from within the United States. We do not imply or guarantee that the Services, their content, or any portion of them are suitable for use in other countries or in any other jurisdictions other than the United States. If and to the extent local laws are relevant, those who choose to use the Services from other places or jurisdictions do so at their own risk and on their own initiative. They are also accountable for adhering to any local laws, rules, and regulations. At any time, in any place, and at our sole discretion, we may restrict access to the Site or Services, in whole or in part, for any person, region, or legal system. You acknowledge and agree that your use of the Services will be governed by this Agreement, our Privacy Notice, and any additional posted guidelines that apply to your use of the Services and which are governed by Texas law, except its provisions on conflicts of laws. You hereby agree and expressly consent to the exercise of personal jurisdiction in the courts of Texas in connection with any such dispute, including any claim involving the Organization and its affiliates and their respective employees, contractors, officers, directors, and suppliers. You further agree and expressly consent to the exercise of personal jurisdiction in the courts of Texas in connection with any such dispute.

16. Severability:

This Agreement shall be interpreted in accordance with relevant law if any section is found to be illegal or unenforceable, and the remaining portions will otherwise be given full legal force and effect. Anywhere this Agreement conflicts or is inconsistent with any Content, this Agreement will prevail. Any provision of this Agreement that is not enforced by us shall not be deemed to be waived by us, including our right to do so. Any termination of this Agreement will not affect our rights under it.

17. Entire Agreement:

The Cairo Brown Foundation and you are the parties to this Agreement.

THIS AGREEMENT CONTAINS PROVISIONS THAT LIMIT OUR LIABILITY TO YOU, INCLUDING WARRANTY DISCLAIMERS. USE OF, ACCESS TO, AND/OR BROWSING OUR WEBSITE CONSTITUTES ACCEPTANCE OF THESE TERMS AND CONDITIONS, SO PLEASE READ THEM CAREFULLY AND IN THEIR ENTIRETY. PLEASE QUIT OUR WEBSITE IMMEDIATELY AND DO NOT USE, ACCESS, AND/OR BROWSE IT ANY FURTHER IF YOU DO NOT AGREE TO BE BOUND BY EACH AND EVERY TERM AND CONDITION SET FORTH HEREIN.

The Cairo Brown Foundation and you are parties to this Agreement, which, unless otherwise specified, governs our Website, Services, and the subject matter hereof, and which replaces all prior agreements, representations, warranties, and understandings. However, you might also need to accept additional terms and conditions to use our website and/or services. Unless otherwise specified, such additional terms and conditions shall be integrated into this Agreement.

Contact Us 

If you have any questions regarding this Agreement, please direct such questions to 

Cairo Brown Foundation 

312 East Avenue B Suite A

Killeen, TX 76541

737-747-8367

contact@thecairobrownfoundation.org