The Rock Counseling Group - Champaign IL

Informed Consent for Treatment and Acknowledgement of Understanding

Welcome to The Rock Counseling Group. This document contains important information about our professional services and business policies. It also contains summary information about the Health Insurance Portability and Accountability Act (HIPAA), a federal law that provides privacy protections and patient rights about the use and disclosure of your Protected Health Information (PHI) for the purposes of treatment, payment, and health care operations. We can discuss any questions you have when you sign them or at any time in the future.

Risks/Benefits of Counseling 
Therapy and Counseling is a process that has both benefits and risks. Some of the risks involved in therapy could include experiencing uncomfortable or painful feelings such as anger, sadness, and guilt. However, psychotherapy has many benefits as well. Psychotherapy can increase communication skills, improve relationships, increase insight and awareness, provide skills for coping with stress and resolving conflict, and create a sense of hopeThe therapeutic success relies heavily on the participation and effort of the client.

Client progress in treatment, the content of therapy sessions, and any information provided to The Rock Counseling Group over the course of treatment is protected by legal confidentiality, HIPPA, and State of Illinois privacy Standards.  

Exceptions to this are as follows: 

  • Insurance carriers require us to disclose client’s eligibility criteria and diagnosis so they can apply your insurance benefits to the services provided. 
  • If the client/guardian gives written consent to release the information to another party 
  • If the client discloses the intention to seriously harm themselves 
  • If the client discloses the intention to seriously harm another identified person
  • If the client discloses the abuse (current or past) of a child, elderly person, or other vulnerable person as The Rock Counseling Group Staff are mandated reporters.
  • If a judge or court orders the release of records

Our Clinicians receive additional supervision from licensed mental health professionals within The Rock Counseling Group to provide our clients with the best services possible. Please note that they may discloseidentifying information about a therapy session in consultation with their clinical supervisorHowever, all confidentiality practices explained above will be applied to ensure client privacy is maintained.

Fees and Financial Responsibility
In addition to the fee for the session which was discussed prior with our patient accounts department. There could be Fees associated with the preparation of assessment and other reports, telephone conversations, consultations, or meetings you have authorized as part of your counseling process. Insurance will be billed if eligible. Insurance co-pays are due at the time of visit and can be paid in the office, over the phone, or online using our website payment portal.  

If insurance does not pay reimburse for the session or deductible, co-pay, or co-insurance amounts are due the client or financially parent, guardian, or legal representative is responsible for all fees associated with services provided.

Cancellations and No-Show Fees 
Clients are responsible for informing the front desk within 24 hours if they are unable to attend their scheduled appointment either by calling the office or contacting their provider. If calling after hours a message can be left on our 24-hour voice mail system. There is a $35.00 fee for late cancellation or not attending a scheduled appointment. After three “no-call, no-show” sessions (where advanced notice was not given of the cancellation), or 3 consecutive cancellations of scheduled sessions services are eligible to be terminated

Counseling services

Children, adolescents, families, and individuals can all benefit from a helping hand and a listening ear at certain times that can help provide insight, support, and new strategies for all types of life challenges.


Even highly motivated, upwardly-mobile, educated, generally healthy people can sometimes use a helping hand to make their lives even better! The Rock helps you develop leadership skills that will not only grown your career, but enhance your life.

201 West Springfield Avenue, Suite 1201 Champaign, Il 61820


1002 Commercial Drive, Suite 2, Mahomet, Il 61853

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The Rock Counseling Group - Champaign IL


Proud Members of:

Champaign County Chamber of Commerce Member Mahomet, IL Area Chamber of Commerce Member Badge Champaign, Illinois West Rotary Membership The Rock Counseling Group