JACQUELINE ELLIFF: Consent to Treatment

Thank you for completing this form. Once all the paperwork is completed, Jacqueline will reach out to get you on her calendar!

JACQUELINE ELLIFF, LPC: Consent to treatment

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Client(s) Name(s)(Required)
What is your relationship to the client?(Required)

JACQUELINE ELLIFF, LPC

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Counseling offices are designed to be a confidential and safe space. There will be NO recording of any sessions or other therapeutic conversations. By typing your name below, you agree to this policy.(Required)

In an Emergency

As is the case with most outpatient therapists, your counselor is not available at all times. Lighthouse encourages clients to develop additional support systems and to have access to other individuals and/or agencies in case of emergencies. Listed below are local emergency telephone numbers should you need them: Colorado Crisis Support: (970) 494-4200 Walk-in crisis center: 1217 Riverside Dr. Fort Collins, 80524 Crisis Assessment Center at Poudre Valley Hospital: (970) 495-7000 Call 911 or go to the nearest hospital emergency room
This field is for validation purposes and should be left unchanged.