(609) 975-9412
You can contact me by email, phone, or text using the contact information listed at the top and bottom of this page for a free consultation.
cnoelletaylor@exhalecounselingnj.com
Client Contact Information
This form is for routine, non-urgent communication only and does not create an emergency service or a therapeutic relationship until confirmed by the counselor.
Telehealth Consent
At Exhale Counseling LLC, our telehealth services are conducted via secure video and phone platforms to protect your confidentiality. While we use HIPAA-compliant technology to safeguard your information, please understand that electronic communication inherently involves some privacy risks. Clients are responsible for ensuring they have a private, quiet space and a stable internet connection for our sessions. Telehealth may not be appropriate in all situations; if specialized or in-person care becomes necessary for your clinical progress or safety, we will guide you toward appropriate transition options.
Credit Card Authorization Form
By signing below, I authorize Exhale Counseling LLC to charge the credit card I provide for the cost of counseling services that I receive. I understand that charges may include:
• Session fees for individual and couples counseling
• Late cancellation fees when an appointment is canceled with less than 24 hours’ notice
• No-show fees when I miss a scheduled appointment without prior notice
I understand that my card information will be used only to process payments for these charges and will not be stored on file for any other recurring or future use without my consent. I agree to notify Exhale Counseling LLC if my card information changes or if I wish to use a different form of payment.
No-Show Policy
Appointments must be canceled at least 24 hours before the scheduled time or the client will be charged a $50 no-show fee. The card on file may be used for this charge.
Informed Consent for Treatment
Counseling is a collaborative process involving the discussion of personal and sometimes difficult topics. While therapy offers potential for significant growth and improved well-being, it involves certain risks such as temporary emotional discomfort, and specific clinical outcomes cannot be guaranteed.
You have the right to be treated with dignity and respect, to ask any questions about your treatment or the therapeutic process, and to participate actively in your treatment planning. You may choose to refuse or pause treatment at any time, subject to clinical and legal considerations.
Your confidentiality is a priority at Exhale Counseling LLC; however, there are legal and ethical limits. These include mandated reporting of suspected child abuse or neglect, situations involving danger to yourself or others, compliance with court orders, and other legal exceptions defined by New Jersey law.
My role is to serve as your therapist for mental health counseling, providing recommendations and referrals as needed. I am not a medical doctor and do not provide emergency services. In the event of an emergency, please contact 911 or visit the closest emergency room immediately.