Disclosure Statement and Confidentiality Agreement
Jennifer Corey, MA
Personal Background and Therapy Training
I received my Masters in Counseling Psychology from Naropa University in Boulder
Colorado. I hold a Bachelor of General Studies with concentrations in psychology,
photography and fine arts, from the University of Dayton in Dayton Ohio. I have
additional training in Body Psychotherapy, Trauma work, and Gestalt from the Boulder
Psychotherapy Institute. I am a member of the Colorado Association of Psychotherapists,
and the United States Association for Body Psychotherapy.
Colorado Department of Regulatory Agencies
The practice of licensed and unlicensed persons in the field of psychotherapy is regulated
by the Colorado Department of Regulatory Agencies. The address for the Mental health
Section responsible for licensed and unlicensed psychotherapists is:
Department of Regulatory Agencies
Division of Registrations
Mental Health Section
1560 Broadway, Suite 1350
Denver, CO 80202
My responsibilities to you:
With the exception of specific legal circumstances described below, you have the
absolute right to the confidentiality of your therapy. I cannot and will not disclose to
anyone what we discuss in session, or that you are even in counseling, without your
The following are legal exceptions to your right to confidentiality. I would inform you of
any time when I think I will have to put these into effect.
1. If I have good reason to believe that you will harm another person, I must attempt to
inform that person and warn them of your intentions. I must also contact the police and
ask them to protect your intended victim.
2. If I have good reason to believe that you are abusing or neglecting a child or
vulnerable adult, or if you give me information about someone else who is doing this, I
must inform Child Protective Services and Adult Protective Services.
3. If I believe that you are in imminent danger of harming yourself, I may legally break