Agreement & Consent Form

Please review the Agreement & Consent Form below before completing the “Request for Consultation” questionnaire.  If you accept the terms and agreements of the “Agreement & Consent” form, then please proceed to the questionnaire.

As a client of LifeQuest Christian Counseling Services, Inc., I understand that I must be at least eighteen years of age to consent to counseling services with LifeQuest Christian Counseling Services Inc.   (All individuals under eighteen years of age must provide written authorization from a parent or legal guardian).  As a client of LifeQuest Christian Counseling Services, Inc.  I declare that I am free of suicidal ideations.  I also understand that LifeQuest Christian Counseling Services Inc., may be required to violate confidentiality to make appropriate legal notifications if there is a reasonable belief that I, the client is involved in child abuse, elder abuse, or self-inflicted harm.

As a client of LifeQuest Christian Counseling Services, Inc., I understand that Online Counseling is technical in nature and that there may be problems with the internet connectivity, which is not the fault of LifeQuest Christian Counseling Services, Inc., or myself, the client.  Internet availability may be limited or disrupted by things such as server maintenance, upgrades, or other various problems, or natural man-made disasters (terrorist acts, internet viruses, etc).  These kinds of problems are beyond the control of LifeQuest Christian Counseling Services, Inc.   If any disruptions or cancellations should occur that are caused by the reasons listed above, all such sessions and or appointments will be rescheduled at no additional charge to you, the client.

I, the client understand that LifeQuest Christian Counseling Services, Inc.  is  licensed and incorporated in the state of Missouri and that it is subject only to the laws and regulations of the state of Missouri.

LifeQuest Christian Counseling Services has taken significant steps to ensure the confidentiality and privacy of online communications, these steps in whole or in part, cannot guarantee the security of internet transactions.  I agree to release and indemnify LifeQuest Christian Services, Inc., from suits, claims, and other actions originating from counseling provided by LifeQuest Christian Counseling Services, Inc.