Fill and Sign the Information Privacy Policy

PRIVACY AND CONFIDENTIALITY POLICY FOR CREDIT COUNSELING SERVICES _______________________________________ (Name) CREDIT COUNSELING SERVICES EMPOWERING PEOPLE FOR CHANGE PRIVACY AND CONFIDENTIALITY POLICY: In accordance with our commitment to the credit counseling profession, all consultations and communications are confidential and private. Your personal information is not shared with anyone other than our staff on a need to know basis . Clients may request to have family members participate in sessions or receive information regarding the counseling process. If so, they understand a certain amount of confidentiality may be lost. We may provide necessary personal information to a third party (a) with your authorization, (b) in compliance with any subpoena, court order, or legal process, that we determine, in our sole and absolute discretion, to be necessary or appropriate, and/or (c) when disclosure is necessary to prevent clear and imminent danger of physical harm to you or others. We realize that the concerns that you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be handled legally and ethically. The undersigned hereby agrees to this privacy and confidentiality policy. _______________________________ DATE: ___________________ CLIENT’S SIGNATURE _______________________________ DATE: ____________________ CLIENT’S SIGNATURE