Conflict Resolution Institute (CRI)
2026 Austin Dr., Novi, MI 48377;
T-248-385-3498; F-810-213-0555; contact@ConflictResolutionInstitute.com
Disclosure & Informed Consent Statement
[X] Qualifications
Master Conflict Resolution Specialist, Mediator/Trainer: Domestic & Civil, MCC & ADRC, 2009
Spring Arbor University, M.A. in Counseling, 2017
National Certified Counselor, NCC, 2017
Licensed Professional Counselor, LPC, 2019
[X] Counseling Experience
Experience diagnosing, assessing & treating a wide range of mental health disorders & their effects with individuals, couples, & families, including those related to Anxiety, Depression, Trauma, Psychosis, Compulsions, Impulsivity, Conduct, Attention, Substance Abuse & Addictions of many types.
[X] Counseling Practice
My practice is rooted in the Evidence-Based, Third-Wave, Transdiagnostic, Process-Based and Mindfulness-Based therapy of the Contextual Behavioral Science tradition, Acceptance and Commitment Therapy, whose targets are the components of the Psychological Flexibility Model.
We approach Mental Health wholistically and are open to dialogue/work with clients on Mental and Emotional Health, Physical Exercise and Activities Health, Nutritional & Metabolic Health and Spiritual Health.
[X] Diagnosis:
If the client seeks Health Insurance reimbursement, a mental-health disorder diagnosis will be necessary. Diagnoses become part of the client’s permanent insurance records.
[X] Confidentiality:
Communications are confidential with the following exceptions:
The client directs the counselor in writing to disclose information to someone else
The counselor thinks the client poses a danger to self or others
The counselor detects child, spouse or elder abuse
The client informs the counselor of positive HIV status
The counselor is ordered by a court to disclose information
The counselor reviews cases with a team of LPCs
[X] Voluntary Treatment:
The client has the right to terminate treatment without cause. CRI has the right to refer client(s) to a more suitable counselor when deemed necessary.
[X] Complaints:
A client may file a complaint with the Michigan Department of Licensing and Regulatory Affairs, Bureau of Professional Licensing, Investigations & Inspections Division, P.O. Box 30670, Lansing, MI 48909, (517) 241-0205.
[X] Results & Risks:
The client recognizes the change process involves changing one’s self concept, perspective, behaviors and relationships. CRI does not force or recommend changes, rather talks to the client about options and uses evidence-based techniques to help. CRI does not guarantee results. The client does not hold CRI responsible for its efforts to assist the client with his/her problem.
[ ] SMS Appointment Reminders
CRI offers automated SMS appointment reminders to clients with scheduled sessions. These text messages contain only the date, time, and location of your scheduled appointment, along with a way to confirm, cancel, or reschedule. Consent is voluntary and is not a condition of receiving services or treatment. Message frequency varies. Message and data rates may apply. You may reply STOP to opt out at any time, or HELP for help.
Your information will not be sold or shared with any third parties for promotional or marketing purposes.
Yes, I consent to receive automated SMS appointment reminders from Conflict Resolution Institute at the mobile number I provide. I understand message frequency varies, message and data rates may apply, and I can reply STOP to opt out or HELP for help at any time.
Mobile Number
Acceptance of Terms
: We agree to these terms and will abide by these guidelines.
Client/Guardian First Name
Client/Guardian
Last Name
Client/Guardian Signature
Reset Signature
Date of Consent
Conflict Resolution Institute (CRI)