SAMPLE FORMS AND TEMPLATES

Consistent with the 2023 Code of Professional Ethics for Certified Rehabilitation Counselors, the use of professional disclosure forms are required.

Specifically, Standard A.3.a states: “CRCs/CCRCs must review with clients, both orally and in writing, the rights and responsibilities of both the CRC/CCRC and client and document the process has occurred.¬† ¬†These are presented in a manner that is accessible and understandable to the client….”

The Standard further describes issues that should, at a minimum, be included.

CRCC offers sample professional disclosure forms; however, the forms below require review for applicability and modifications must be made as appropriate. Revisions for releases may also be required based on various laws or based on HIPAA requirements for transfer of medical records.