Connections in Counseling with Crissa Harman, LMHC

Client Intake

New Client Intake

Hi there,

I’m so glad you’re here. Beginning therapy—or starting with a new therapist—can bring up a mix of emotions: hope, hesitation, curiosity, even overwhelm. That’s completely normal. My intention is to make this process as clear, supportive, and grounded as possible.

This packet includes information about how I practice, what you can expect from our work together, and the policies that help create a safe and respectful space. My approach is relational, warm but direct, and rooted in the belief that meaningful change happens in connection. I hold space with both gentleness and structure, and I’m deeply honored to walk alongside the people I work with.

If anything in this packet brings up questions or doesn’t quite make sense, don’t hesitate to ask. You don’t have to figure everything out on your own—that’s what I'm here for.

Looking forward to getting to know you.

Warmly,
Crissa Harman, LMHC

Informed Consent for Concierge Counseling Services

Overview of Services

You are engaging in concierge counseling services provided by a licensed mental health professional. These services are designed to be flexible, personalized, and delivered in a setting that is convenient and private—such as your home, office, assisted living facility, or via secure telehealth.

Nature of Counseling *

Counseling is a collaborative process intended to support emotional well-being, improve coping skills, and address issues such as depression, anxiety, grief, life transitions, relationship concerns, and other mental health or quality-of-life issues.

While counseling can be beneficial, it may also bring up difficult emotions or memories. Progress may take time and is influenced by many factors, including your level of participation and the nature of your concerns.

Who May Not Be a Good Fit for Concierge Counseling *

Concierge therapy offers personalized care with flexible access—but it may not be the right fit for everyone. At this time, Connections in Counseling may not be able to meet the needs of clients who:

  • Are experiencing severe or unmanaged substance use concerns
  • Are navigating frequent suicidal ideation or chronic crisis without a stable safety plan
  • Live or travel frequently out-of-state, making it difficult to maintain continuity of care within Florida’s licensing laws
  • Require emergency or on-demand support, as this model is not intended to replace 24/7 crisis services

Confidentiality

Confidentiality *

All information shared in counseling is confidential and will not be disclosed without your written consent, except in the following situations:

  1. If there is suspected abuse or neglect of a child, elderly, or dependent adult.
  2. If you are at risk of serious harm to yourself or others.
  3. If records are subpoenaed by a court of law.
  4. As otherwise required by law.

Your privacy and dignity are deeply valued, and every effort will be made to uphold strict confidentiality within legal and ethical guidelines.

Concierge Model and Fees

Concierge Model and Fees *

This is a concierge, self-pay service, which means:

  1. Services are not billed to insurance
  2. Payment is due at the time of service or as outlined in your service agreement
  3. Package pricing is available and can be selected based on your needs

There is no guarantee of reimbursement from insurance or third-party payers. Clients are solely responsible for all fees associated with services.

Session Fee Agreement
You may choose to book single sessions or enroll in a monthly package for greater access and continuity.
Session fees are not listed here and will be outlined in your personal agreement or invoice.
There is no guarantee of reimbursement from insurance or third-party payers. You are solely responsible for payment.

Scheduling and Cancellation *

Appointments are scheduled directly with your counselor. If you are unable to attend a session, please provide at least 24 hours’ notice to avoid being charged. Sessions canceled without adequate notice may be billed in full.

Scheduling Limitations *

While concierge counseling offers greater flexibility and access than traditional models, there are still some boundaries:

  • Evening and weekend availability (Friday–Sunday) may be limited
  • Therapist is not on-demand—responses may vary due to other professional/personal obligations
  • Missed or canceled sessions may not always be able to be rescheduled within the same week, especially if cancellation occurs late in the week
  • All services are currently only available within the state of Florida, via in-person or secure telehealth sessions

Telehealth

Telehealth (if applicable) *

Some sessions may be provided via secure video conferencing.

You understand that:

  1. Technology-related interruptions may occur
  2. You are responsible for having a private, quiet location for sessions

Your counselor will take reasonable steps to ensure the confidentiality of remote sessions

Client Rights

Client Rights *

You have the right to:

  1. Ask questions at any time
  2. Refuse any treatment or intervention
  3. Discontinue counseling at any time
  4. Receive referrals for additional care if needed

Consent

Consent *

By signing below, you acknowledge that you:

  1. Have read, understood, and agree to the terms outlined in this document
  2. Have had the opportunity to ask questions
  3. Voluntarily consent to receive concierge counseling services

By typing your full name below, you agree that this electronic signature is the legal equivalent of your handwritten signature.

You affirm that:

  • You have read, understood, and agreed to the terms outlined in this informed consent document.
  • You had the opportunity to ask questions.
  • You voluntarily consent to receive counseling services from Crissa Harman, LMHC.
  • You consent to conduct business electronically and to the use of this electronic signature.

Please type your full name in the box below.

Medical & Psychosocial

(There’s no wrong answer. Some people come because of a specific issue; others come just to have a space that’s theirs.)

(It’s okay if you’re not sure yet.)

A copy of your responses will be emailed to the address you provided.