Book Now — Nebraska 117 | Helping Foster Families Thrive

Thank you for reaching out to Nebraska 117 Counseling.

You have taken the first step toward restored hope, renewed life, and increased health.

Please follow the instructions below for setting up a counseling appointment.

To Schedule Your Initial Counseling Session

1) Please click the ‘Consent Form’ button and follow the instructions.

Consent Form

Informed Consent & Release Of Liability

SERVICES OFFERED: I am trained in counseling individuals, couples, families, and groups. I provide counseling to children, adolescents, and adults presenting a wide range of issues. I do not prescribe medication. If you or a family member requires services that I cannot provide, I can assist you in a referral. In our initial session(s), I will gather information about your reasons for pursuing counseling, take a personal history, and review your APS Report. After the evaluation session(s), I will be able to offer you first impressions of what our work together will include and a plan to follow if you decide to continue counseling with me. We will work together to devise a counseling plan that offers reasonable promise of success and is consistent with your abilities and circumstances. We will regularly review the plan to ensure its continued viability and effectiveness. At any time and for any reason, you or I have the right to terminate counseling. If at any time you would like a referral to another counselor, I can provide one. There are no promises of success in counseling. Your progress and success depend upon the amount of time and effort you put into working toward the goals you have established. I provide counseling services in person or by Zoom, but I do not provide counseling by telephone. If you require assistance that involves more than scheduling/rescheduling your appointment or a quick answer to a question regarding counseling services provided, plan to make an additional appointment for counseling. I am an independent, faith-based Licensed Counselor through the National Christian Counseling Association. I am not state licensed or under the regulatory authority of any governmental agency. I am not performing these services as an employee of King of Kings Lutheran Church or The Core Center, LLC. The Counselee further understands that it is the specific intent and purpose of this legal document to release and discharge all claims and causes of action of any kind or nature which are directed toward a counselor and Nebraska 117. APPOINTMENTS AND CANCELLATIONS: The initial session may last up to 90 minutes. Subsequent counseling sessions usually last 50 minutes. If you miss a scheduled appointment, please reschedule, or cancel at least 24 hours in advance. A missed appointment is a lost opportunity for both client and counselor. The counselor has reserved that time for the client. Other clients have not had access to that appointment time because it was held for you. In addition, your counselor considered that appointment time an important part of your counseling. While unforeseen emergencies do occur, please make every effort to keep your appointment as scheduled. When, on occasion, I will be unavailable for appointments, I will make every attempt to inform you of this in advance. If I will be unavailable for an extended time, I will provide you with the name of a colleague to contact, if necessary. E-mail communication can be a convenient means of setting appointment times, but I will not use e-mail as a means of providing counseling. E-mail may not be a secure way of sending and receiving information, and while I make every attempt to keep my e-mails confidential, I am not liable for any breach of confidentiality that results from the use of e-mail communication. CONFIDENTIALITY: Records are maintained for each client. Records may contain the following: identifying information; session notes; any reports from other professionals regarding your treatment; any correspondence or other materials that you send to me; copies of any correspondence about you that I send to others. These records are meant to be a working document to both reflect and guide your counseling work. Your records are confidential and may only be accessed by me. Your records are confidential except in the following circumstances: I am mandated to report physical or sexual abuse of children. I am mandated to report physical abuse of a dependent adult. I am mandated to report threats of suicide or homicide. If you sign a release of information for me to communicate with someone else. Information necessary for supervision or consultation. Information required by law. EMERGENCIES: While I will always try to return your call or e-mail within 24 hours and usually sooner, I am not an emergency mental health service. If you experience an emergency, you should call 911 or go directly to your nearest emergency room. CONSENT FOR COUNSELING OF MINORS: If the child reveals something to me that I believe that child should tell the parents, I will request the child tell the parent in my presence. I will notify the parents if I believe the child is a danger to himself or others. The parent/guardian should sign below if (s) he agrees with this statement.

I Agree

I Do Not Agree

Name

First Name

Last Name

Date

YYYY

2) Please click the ‘Intake Form’ button and fill out the form as completely as possible.

3) Please make payment for the initial counseling session and book your first appointment at the bottom of this page (Sign In and follow the instructions).

Within 24 hours of completing steps 1-3, you will be emailed a link to complete the APS questionnaire. This is an online questionnaire that takes 10 - 15 minutes to complete and will be an important part of your counseling sessions. Please be sure to complete the APS questionnaire prior to your initial counseling appointment.

To Schedule Your 2nd & Subsequent Counseling Session

1) Scroll down to the white box, choose the ‘Counseling Session’ & follow the instructions.