Client Rights and Responsibilities:

All clients served have rights. You will be given a notice of your rights. If you have questions regarding your rights and responsibilities, please speak with your counselor regarding your treatment, or you may speak with the Executive Director.

You have the right to:

1. Not to be denied service based on race, color, national origin, religion, sex, age, mental or physical handicap, marital status, sexual preferences, political beliefs, or the ability to pay.
2. To be respected by your counselor and other staff members.
3. To have a copy of our written fee schedule. This can be obtained from a staff member.
4. To receive an explanation of your bill. This can be obtained from a staff member.
5. To review, copy or receive a summary of your program’s records, unless in the judgment of the Program Director such actions would be harmful to you.
   • If the Program Director or the Therapist determines that you should not see the entire record, portions of the record or a summary of the record can be provided. All requests to review records need to be in writing and directed to the Executive Director.
6. To be informed of any research our program plans to conduct and refuse to participate if you wish.
7. To participate in the development of your treatment plan and be provided a copy of your treatment plan. To refuse treatment. If you refuse treatment, you will be informed of the possible risk and consequences:
   • Possible legal results
   • Medical risk for continuing substance use
   • Potential for further problems
   • Consequences of untreated substance use

You may be offered a referral to another agency or possibly return to treatment here. The reasons why you chose not to participate will be written in your file, and if you are under the jurisdiction of the DOC, Federal, Treatment Court, or any Local Courts, officials will be notified.

Your Responsibilities:

You may be asked to provide the following at first appointment:

• Referral source information
• Insurance Information
• Proof of income (if seeking funding assistance)
• Payment in full
• Driving Record

You must:

1. Show that you can be treated without risk to yourself, other clients, or clinic staff and that you have the need and ability to profit from the services offered.
2. Arrange transportation to and from the clinic. If transportation is an obstacle to accessing treatment, let our staff know, and we may be able to assist you. Unfortunately, we do not have childcare available, and children cannot be left unattended in the waiting area.
3. Be willing to be involved in your own treatment, which may include signing releases of information, consent for treatment and payment agreements. You will also participate in. the development of your own treatment plan.
4. Be sober at the time of your intake/assessment and treatment. You may be asked to leave the building if you are suspected to be under the influence. If it is perceived that you may be a risk to yourself or others, public safety will be notified.