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Please read this Informed Consent page thoroughly and check the boxes below to confirm that you understand.

INFORMED CONSENT FOR DOUG MILLER’S PHD AND ELICIA MILLER’S VIRTUAL RETREAT

Welcome to your Virtual Retreat. This document contains important information about our professional services and business policies. Please read it carefully and jot down any questions you have so that we can discuss them before our meeting, through email or on the telephone. When you sign this document, it will represent an agreement between us and the other members of the Virtual Retreat.

PSYCHOLOGICAL SERVICES
While this is a personal growth workshop, there may be times when you may also engage in psychotherapy, which is often more personal and deeper. Psychotherapy can have benefits and risks. Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. While you will be helped to manage what you share in the Retreat, any disclosures you make and the impact they have on your relationships are your responsibility and are not the responsibility of the Retreat leaders. Of course, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, and significant reductions in feelings of distress. But there are no guarantees of what you will experience.

During the retreat, the participants will be asked and/or guided to engage in various discussions and exercises, it is your responsibility to evaluate whether you are comfortable with any aspect, at each turn, and to inform the leaders if you are not.

CONTACTING US
​Because this Retreat may help you move through difficult psychological, emotional and relationship issues, and is designed to support your personal development, various feelings may emerge and dynamics may change in the days and weeks following the Retreat. If these feel overwhelming or otherwise are difficult to manage, we will be available by email and/or telephone and we will return your communication as soon as we can. If you are difficult to reach, please inform us of some times when you will be available. If you are unable to reach us or feel that you can’t wait for us to return your call, contact your family physician or the nearest emergency room and ask for the psychologist [psychiatrist] on call. You are also free to work with other mental health professionals and other providers as you see fit.

PROFESSIONAL CONFIDENTIALITY AND EXCEPTIONS
In general, the privacy of all communications between a patient and a psychologist is protected by law, and we can only release information about our work to others with your written permission. But there are a few exceptions.

In most legal proceedings, you have the right to prevent Dr. Miller from providing any information about your treatment. In some proceedings involving child custody and those in which your emotional condition is an important issue, a judge may order my testimony if he/she determines that the issues demand it.

There are some situations in which I am legally obligated to take action to protect others from harm, even if I have to reveal some information about a client’s treatment. For example, if I believe that a child [elderly person, or disabled person] is being abused, I may be required to file a report with the appropriate agency.

If I believe that a client is threatening serious bodily harm to another, or themselves, I am required to take protective actions. These actions may include notifying the potential victim, contacting the police, and/or seeking hospitalization for the client. If the client threatens to harm himself/herself, I may be obligated to seek hospitalization for him/her or to contact family members or others who can help provide protection.

These situations have occurred extremely rarely in my practice. If a similar situation occurs, I will make every effort to fully discuss it with you before taking any action.

While this written summary of exceptions to confidentiality should prove helpful in informing you about potential problems, it is important that we discuss any questions or concerns that you may have before or at the beginning of the Retreat. I will be happy to discuss these issues with you if you need specific advice.

WE ARE NOT MEDICAL PROFESSIONALS
Elicia Miller and Doug Miller PhD are not medical doctors, and any opinion and advice regarding nutrition or medical issues is for you to research and/or decide what works for you. The success of an individual and group program, as well as your ability to self-heal, rests mainly on your resolve to focus on your health – now and in the future. Please consult a medical doctor before making any changes.

NON-DISPARAGEMENT:
All participants agree that they will not engage in any conduct or communications, public or private, designed to disparage one another, Elicia Miller, Doug Miller, or her/his associates/entities.

IMPORTANT:
This Retreat is not for those actively addicted to drugs or alcohol. If you are taking psychiatric medications, please contact Dr. Miller by email and arrange a time to discuss these with him.

PRIVACY POLICY:
​In addition to the terms outlined above, submission of this form confirms you have read, understand, and agree to our Privacy Policy terms. All group session recordings are private and confidential and are not to be shared with anyone else.

CANCELLATION POLICY:
Please note that all services are not refundable.

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