I understand and agree to the following statements:

Dr. Bosworth's Pastoral Counseling Agreement

I have read and understand the following pages of this website:

  • Counseling appointments are usually scheduled  for forty-five through fifty minutes.
  • Client and Counselor are to arrive on time and prepared for each session, including having all homework completed.
  • Clients will be billed for $25 if he/they miss an appointment without providing 24 hour's notice to the counselor.
  • The counselor may adjust the above fee at his discretion in case of emergency.
  • ​The counselor will cancel/reschedule sessions only when absolutely necessary, giving the client a reason for so doing.
  • Client and Counselor will silence all electronic devices and will not answer them during sessions.
  • Children under the age of fourteen will not be left unsupervised in the building during counseling sessions.
  • Dr. Bosworth does not provide child-sitting services.
  • Client will not hold counselor or hosting building responsible for any damage done to cars driven to sessions.
  • Client will provide the counselor with what he/they would like addressed/worked on in any particular session.
  • Client agrees to inform the counselor in writing of any changes in contact information and/or medication.
  • Client/Counselor relationships work best when the client does not engage other counselors to discuss the same subjects.
  • Counselor will give  client(s) an explanation in writing why the counselor/client relationship is to be terminated.
  • The counselor and client(s) will agree on a fee before or during the first counseling session.

With respect to client/counselor confidentiality, I understand the following statements.

  • Counselor will keep confidential what is told privately in counseling sessions. 
  • All client information will be kept in locked files for client privacy and security. 
  • HIPPA guidelines will be followed; clients will receive a handout with respect to these guidelines.  
  • Confidential information will not be released to anyone without the client's written consent. 
  • Information with respect to Child Abuse will be reported in accordance with State Law KRS 630.020 
  • KRS 209A.030 mandates the same for reporting adult abuse, which includes spouse abuse.
  • KRS 202A.400 mandates counselors to warn intended victims of client's threats of violence.
  • When a counselor judges a client to be at immediate risk for suicide and/or in need of emergency hospitalization,...........confidentiality is waived for the protection of the client.

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to download a copy of the Application for Counseling which  must be complete before or at the first session.

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Dr. Bosworth's Pastoral Counseling Agreement

I have read and understand the following pages of this website:​​

Fort Worth, Texas

Robert W. Bosworth, Jr.,

M.Div, Ph.D.

​Licensed Clinical Professional Pastoral Counseling

Call Us:  (859) 475-4475