Policies 


  1. CANCELLATION. If an appointment needs to be canceled please do so at least 24 hours in advance. If sessions are no showed or canceled late on a frequent basis (more than three times) the client will referred to another provider/private practice due to frequent no shows/cancellations. 
  2. RESCHEDULING. Clients can reschedule an appointment by emailing imaginecounseling1@gmail.com, 
  3. CO-PAYMENTS AND BALANCES. All co-payments must be paid the day of the service and training fees paid after the completion of a training/consultation service. If utilizing an insurance plan, the patient will be responsible for any portion the insurance provider does not pay. It is important for the client to keep track of the deductible and understand all fees will be paid by the client until the client's insurance deductible has been met. 
  4. CONFIDENTIALITY- GUESTS/PERSONS ATTENDING CLIENT'S SESSIONS-. It is important to protect the client at all times. It is imperative that if the client is attending a virtual session he/she/they attend the session alone in a private an confidential space. Unless the session is a couples or family session, which must be scheduled an advance, only the client should be attending sessions, rather in person or virtual. In the case of counseling with youth, rather in person or virtual, a parent can attend sessions but only if requested by and/or agreed upon by the youth client. 

  5. ALCOHOLIC BEVERAGES. No alcoholic beverages or illegal substances will be permitted inside of sessions and clients are not permitted to attend sessions intoxicated. 
  6.  POLICIES AND WAIVER. All guests are required to comply with the posted rules and regulations of the business space utilized by Imagine Counseling Services (See and Sprout- 709 3rd Ave. Huntington, WV 25701). All guests are required to sign and comply with the Seed and Sprout waiver of liability upon entering the facility. 
licensed professional counselor informed consent document 

​All clients will be provided a general informed consent, as well as a more personalized licensed professional counselor consent specific to the assigned counselor. See the informed consent for the business owner, Candace D. Layne, below. 

Informed Consent for Mental Health Services
Candace D. Layne, EdD, LPC 

By seeking treatment at Imagine Counseling Services you are agreeing to the treatment agreement, confidentiality, and privacy policies. The following is information specific to behavioral health services. 
Credentials, Supervision, Training and Affiliations: 
1. I am a two-time Marshall Alumna having received an MA in Counseling in 2006 and my BA in Psychology in 2004. I received an EdD Educational Leadership degree in 2013 from Argosy University. I am a Licensed Professional Counselor in the state of WV. I have served as Director of the Marshall University Counseling Center since 2018. I am a Certified Peer Educator (CPE) Training Instructor, certified Trainer in QPR- Question, Persuade, Refer Suicide Prevention Training, certified as a Tips for the University Trainer, and I enjoy teaching for Lindsey Wilson College, Mountwest CTC and Bridge Valley CTC. I am also a UNI 101 instructor for Marshall University. I have completed training in Mindfulness techniques, Dialetical Behavior Therapy techniques and Eye Movement Desensitization and Reprocessing (EMDR). I am a Certified Mindfulness-Informed Clinician – Level 1 (CMC-1), and over 16 years of counseling experience in many different counseling and human service environments I adhere to the code of ethics for counseling (copies made available upon request). You may view the ACA code of ethics from their website: www.counseling.org 
2. I am a co-owner of Imagination Station West Virginia LLC, in which Imagine Counseling Services is under the umbrella of this LLC.
Counseling Approaches/Treatment: 
1. From time to time, I may ask you to complete a questionnaire or other assessments of your symptoms. These are used to determine how severe, frequent, or intense your symptoms are in order to provide direction in your treatment plan. These completed assessment tools will be placed in your file as part of your medical record. 
2. I provide eclectic treatment primarily based and focused on Cognitive Behavioral Therapy, Mindfulness, and Solution-Focused strategies. I may also use techniques based on other known psychotherapy approaches such as Impact Therapy, Reality Therapy, Person-Centered Therapy when your goals and symptoms dictate these methods.
Parameters of Voluntary/Involuntary Treatment: 
1. Unless you are mandated into treatment, it is understood that treatment is completely voluntary, and you may terminate treatment at any time. 
2. If you are being mandated for treatment, you must provide a copy of the court order and sign a release to the appropriate parties (BIT team, student success worker, student conduct, etc.) Your confidentiality rights may be limited depending on the nature of the mandating. 
Guarantees, Risks, and Participation: 
1. Please keep in mind that when first beginning therapy, it is possible for you to feel worse before you begin to feel better. This is quite common and I encourage you to discuss this with me should you feel this is the case. Unfortunately, there is no guarantee that any therapy will help you with your problems and that therapy is not a “quick fix”. Results may not be immediate. Success in therapy is directly related to the amount of time and effort you put into it and personal change doesn’t generally come quickly or easily. 
2. There can be some risks to change that may be unpleasant (i.e. negative reactions from others to your personal changes, possible increased conflicts as you become more assertive, etc.). There are also potential risks that accompany NOT receiving therapy which may include but are not limited to: continuation of the presenting problems, worsening of the presenting problem, and/or needing a higher level of care in the future. 
3. Failure to comply and participate in therapy sessions may result in disruption of treatment with me, as I fully believe you can only get better if both us are doing our part. If this is a concern, we will discuss and proceed from there. 
4. If you come to your session intoxicated or I suspect that you are intoxicated, I reserve the right to end the session and reschedule you. 
Frequency and Duration of Treatment: 
1. The frequency of treatment varies from client to client. The frequency of your appointments with me depends on my availability, your preference, and the severity of your presenting problem (s). 
2. The duration of your treatment with me depends on several factors: how often you see me, how much you participate in your treatment, the severity of your problem(s), and other possible extenuating circumstances. 
Referrals: 
1. If I do not have the knowledge, competence, or skill to help you with your specific problem, I will share my concerns with you and will either refer you for complimentary services or to another therapist with appropriate training and/or expertise. Though I appreciate any faith you may have in my skills or abilities, it is unethical for me to treat you outside the scope of my practice. It is understood that you are voluntarily choosing to see me for psychotherapy and may terminate your services with me at any time without any negative consequences (unless mandated). 
2. There may be times that I may suggest referrals to other providers for services to address various aspects of your care. This may include but not be limited to psychological testing, medical tests or visits, wellness or preventive care, student advocacy, etc. When necessary, I will have you sign a Release of Information to the person or agency to expedite your care.
Cancellations and Messages: Due to my full schedule, I most always have clients that would like to be called if I have openings due to cancellations. Please let me know if you are unable to keep your appointment as soon as you know you cannot come. Please email me at candace.layne@imaginationstationwv.com or call 304-633-7751. I can also be reached on my office. Please leave a voicemail if unanswered. You can reschedule your appts. with me at my personal scheduling link in the Simple Practice Client Portal. 
3. No Shows and Tardiness: If you miss an appointment without calling to cancel or fail to give 24-hour notice, this is referred to as a “no-show”. If you “no-show” and have another appointment scheduled, you can be reminded via text message if you wish to be. Please be aware that missing an appointment could result in a 1-2 week waiting period for another open appointment spot. 
4. Appointment Reminders: As a courtesy and with your permission, you will be texted to be reminded of your appointment. 
5. Technology: I do not communicate via social media. If you email, I will keep information short due to privacy issues. This form of communication is not a substitute for therapy. 
a. The Counseling Center and the ACA code of ethics prohibits the interaction of staff and clients on social media such as Facebook, Twitter, etc. 
b. I do not share any personal contact information with any client and will not do so under any circumstances. 
6. Documentation: It is required that I document your services after our sessions are completed to help maintain a focus of your treatment. At times, I may begin documentation with you present. Let me know if you have any questions or concerns about this process. Documentation will only be shared if it is court ordered or you sign a release of this information. You may request your documentation at any time; however, it can take 24-48 hours for these to be completed. 
Online Scheduling: 
1. If I need to reschedule an appointment, I will try to reschedule you as soon as possible. If you need to reschedule an already scheduled appointment or schedule a new one with me, please contact me via email or phone. 
Death or Incapacitation 
1. Should I unexpectedly become incapacitated/die and can no longer provide services to you, you will be reassigned to another therapist if you wish to continue therapy Imagine Counseling Services or you will be referred to a counselor/therapist in the community. 
Office Hours and Policies: 
1. Counseling hours are by appointment only scheduled with the therapist. 
2. Our sessions will last 45-60 minutes, whichever is best for the client needs and depending on the time you arrive. If you have any urgent matters to discuss with me, please bring them up at the beginning of our session so adequate time can be given to them. 
3. Please do not bring children of any age to your sessions unless we have agreed to this prior to the appointment. If they come with you, they must be old enough to sit in the lobby by themselves during your session or we will have to reschedule your appointment. 
4. Please refrain from cell phone use during our sessions unless it is an emergency. Excessive non-emergency calls may be cause to end our session. I leave my cell phone on for emergency purposes and reserve the right to interrupt our session if there is an emergency. 
5. If you are sick, especially if you have a fever, please do not come to your appointment. If you come to an appointment and I am concerned about your health, I reserve the right to cancel your appointment and reschedule for a time you feel better. If I am sick or unable to come to work on a day you are scheduled to see me, someone from this office will attempt to call you to cancel. Please reschedule at this time. 
6. If you have a crisis, you can contact MUPD on the crisis line at (304) 696-HELP 24 hours 7 days a week. If in need of immediate assistance, please contact 911. The National Suicide Hotline can be reached at (800) 273-8255
Confidentiality, Release of Information and Access to Records: 
1. All information that you share with me or any Counseling Center employee is kept strictly confidential. Whenever you request that we share information about you to others, we will obtain your signed, written consent to do so. Though this is sometimes inconvenient for you, please remember this rule protects you and your privacy. If you ask me, I can release parts of your records on file to any person you specify with your written permission. I will tell you whether or not I think releasing that information to that agency or person may not be in your best interest or harmful to you. You have the right to limit information shared with others and can revoke any release you sign at any time. 
a. The exceptions to this rule include when we have reason to believe you are at serious risk of harming yourself or someone else, if we hear of any child or adult abuse, neglect or exploitation, or when the information in your file has been court ordered to be released. I am considered a Mandatory Reporter in the State of WV which means I am legally and ethically required to report any information suggesting child or elder abuse, neglect or exploitation. I am not legally required to tell you of my actions if I release information about you under these circumstance. 
2. If you and your spouse/partner are being seen for couples, or it is agreed I will meet with you and your spouse/partner, there are regulations regarding confidentiality and access to records in these circumstances. In order for me to share information to either/all of you in and outside of sessions, I must have a signed authorization to release information by each of you to the other. If one party requests or subpoenas joint counseling records in the future, a written authorization of all parties will need to be signed or a court order must be obtained before any information will be released. 
3. Your record is maintained and stored electronically but is also available to other staff– as they are considered the custodian of the record and can access your record when or if I am unavailable. To obtain a summary of your records you will be asked to sign a release of information. 
4. If you request a letter to be written on your behalf, it will be necessary to sign a sharing of information regardless of whether it is to be sent or given to you. 
5. In general, any information released from me or this agency re: you or your care requires a signed authorization to release information by you. If someone calls or contacts me on your behalf, I cannot confirm nor deny any information about you or your treatment and reserve the right to withhold information or refuse contact with that person. Also, I cannot copy information from your file or write a letter for you without a signed release, even if it is a release to yourself. 
6. If you see me outside of the Imagine Counseling Services office, in order to protect your privacy, I will not acknowledge you unless you acknowledge me first. If you are uncomfortable speaking to me outside of sessions you are under no obligation to do so. I cannot conduct therapy in a public, on the phone or by email. 
Client Rights 
You also have other rights that were provided to you upon admission. You 
have the right to file a complaint or grievance against me or anyone at our agency if you feel your rights have been violated in any way. If you are concerned with the quality of care that I am providing, please speak with me or my supervisor about your concern so that we may rectify the situation. Please let me know if you have any questions about these rights or the complaint/grievance process. Forms to document your complaint or grievance are available upon request. However, if you believe that I have behaved in an unethical manner regarding the delivery of services, you can also contact my licensing board.

​
completion of paperwork prior to first appointment 

  1. CANCELLATION. Your party deposit or full payment is not refundable when there are fourteen (14) days or less to your party date. Refunds may take up to 15 days to process. 
  2. RESCHEDULING. You may transfer your deposit to an available party date and time when there are fourteen (14) days or less to your party date. A $50 processing fee will be applied to any party that needs to be rescheduled with less than fourteen (14) days of party date. A party may not be rescheduled more than once. 
  3. REMAINING BALANCE. The remaining balance of your party must be paid in full on the day of the scheduled event. 
  4. GUESTS. A party is limited to fifteen (15) children ages 0 to 9 years of age.  Each child will be granted playground access. 

  5. ALCOHOLIC BEVERAGES. No alcoholic beverages or illegal substances will be permitted inside Imagination Station Indoor Playground and Party Center.  
  6.  POLICIES AND WAIVER. All guests are required to comply with the posted rules and regulations.  All guests are required to sign and comply with the Imagination Station Indoor Playground and Party Center waiver of liability upon entering the facility. 
in case of illness 
Due to the ongoing uncertainties surrounding COVID-19 and other transmittable illnesses, please DO NOT attend in person sessions if:
  • You have been in contact with someone who has tested positive for COVID-19 within the last 14 days;
  • You are experiencing a fever, sore throat, or shortened breath;
  • You have a cough or are sneezing.

Imagination Station Indoor Playground & Party Center / Imagine Counseling Services works diligently to ensure that all equipment is properly sanitized throughout the day.  Although sanitation efforts are in place, we can not guarantee that COVID-19 will not be spread to others while in our facility.  Please wear masks at your own discretion. 
release of information form 

​If a client would like to request a specific part of his/her/their record, or all of the health record, a client must complete the following release of information form prior to the counselor releasing the record. The counselor will also schedule a time to review the record with the client prior to the release of any information. 

* Client's name:​
* I authorize [NAME OF PRACTICE or CLINICIAN'S NAME] to:
 Send
 Receive
The following information:
 Medical history and evaluation(s) 
 Mental health evaluations
 Developmental and/or social history
 Educational records
 Progress notes, and treatment or closing summary
 Other
To / From:
Phone:
* Your relationship to client:
 Self
 Parent/legal guardian
 Personal representative
 Other
* The above information will be used for the following purposes:
 Planning appropriate treatment or program 
 Continuing appropriate treatment or program
 Determining eligibility for benefits or program 
 Case review 
 Updating files 
 OtherI understand that this information may be protected by Title 45 (Code of Federal Rules of Privacy of Individually Identifiable Health Information, Parts 160 and 164) and Title 42 (Federal Rules of Confidentiality of Alcohol and Drug Abuse Patient Records, Chapter 1, Part 2), plus applicable state laws. I further understand that the information disclosed to the recipient may not be protected under these guidelines if they are not a health care provider covered by state or federal rules.
I understand that this authorization is voluntary, and I may revoke this consent at any time by providing written notice, and after (some states vary, usually 1 year) this consent automatically expires. I have been informed what information will be given, its purpose, and who will receive the information. I understand that I have a right to receive a copy of this authorization. I understand that I have a right to refuse to sign this authorization.
If you are the legal guardian or representative appointed by the court for the client, please attach a copy of this authorization to receive this protected health information.

*  Signature:
By checking this, you are eSigning this form.
* Date:
Witness signature (if client is unable to sign):
Witness Date:
EMOTIONAL SUPPORT ANIMALS