The majority of this document is mandated by both South Carolina State law and Public Law 104191;

it is provided for your protection. Be Still Counseling, LLC has worked hard to anticipate any 

obstacles you may experience by coming into treatment, please call Ashley Lauderdale with any

questions about the following document.

Contact information  Be Still Counseling is located at 1 Carriage Lane, building D Charleston, SC 29407.

Our operating hours are from 830am-2pm Monday-Thursday. After hour requests can be made but will 

not be used on a regular basis. Fridays are utilized for workshops at the office and make up sessions

throughout the week.  Be Still Counseling's  phone number is 843-367-3490 (voicemail is confidential). 

More information can be obtained on the website www.Bestillcounselingsc.com. Phone and email are

checked one time a day and therapist and/or practice manager will return all messages within 24 hours.

Personal qualifications  Ashley Lauderdale, MA LPC is a licensed therapist (5321) in the state of South 

Carolina. Ashley graduated from The University of Tennessee Summa Cum Laude in 2003, with a degree 

in Psychology. Ashley moved to Charleston and received a Master's in Counseling with a focus on Marriage 

and Family Counseling from Webster University in 2005.  See website for more information on services 

offered.  Ashley Lauderdale, MA LPC is licensed through the SC Board of Examiners for The Licensure of 

Professional Counselors, Marriage and Family Therapists, and Psycho-educational Specialists; this board 

is located in The Synergy Center (Kingstree Building) in Columbia, South Carolina at 803-896-4652 (mailing

 address is P.O Box 11329, Columbia, SC 29211-1329.  The Executive Administrator for Be Still Counseling,

LLC is Ashley Lauderdale, MA LPC. She is a confidential administrator under the state and federal law.

She will be your contact for appointments concerns, and commendations.

Confidentiality 

The information you share in psychotherapy is protected health information and is generally confidential

by both South Carolina statute law and federal regulations. 

Your therapy file can be subpoenaed in South Carolina through a court order (signed only by a judge) but

is considered privileged in the federal court system. Ashley Lauderdale, MA LPC is mandated by Duty to 

Warn-to breach confidentiality if he/she discovers: 1) you are threatening self-harm or suicide, 2) you

are threatening to harm another or homicide, 3) a child has been or is being abused or neglected, 4) a 

vulnerable adult has been or is being abused or neglected, 5) animals are being abused or neglected. 

Finally, if you wish you protected health information to be shared with another party, you must sign a 

Release of Information.  

Ethics

Be Still Counseling, Ashley Lauderdale, MA LPC adheres to the following code of ethics:

The South Carolina Board of Examiners for The Licensure of Professional Counselors,Marriage and 

Family Therapists, and Psycho-educational Specialists. Therapist cannot have any type of relationship 

with clients outside the counseling setting, cannot except gifts from clients, and any type of sexual 

contact is unethical.

Informed Consent 

At the end of this document you will be asked to sign indicating that you have been given this document 

and the HIPAA document that follows. Your signature indicates that you have read and understand the

documents and that you consent to treatment. Please be aware of the following:

1. Ashley Lauderdale, MA LPC is not a doctor and as a result cannot prescribed medication

2. Getting treatment at Be Still Counseling does not guarantee results. All mental health treatment is 

subjective with success meaning different things to different people.

3. Ashley Lauderdale, MA LPC may ask to consult with your general physician, psychiatrist, lawyer, and/or 

previous counselor with permission.

4. Ashley Lauderdale is not available after hours or on the weekends. In the case of emergencies that cannot 

wait until working hours mobile crisis 843-414-2350, 911 and/or an agreed safety plan will be implemented.

5. Ashley Lauderdale, MA LPC values your time and in return expects the same. One late cancellation or no 

show will be allowed and after that all cancellations/no show made within 12 hours will be billed fully. To be 

on the safe side attempt to make all cancellations within 24 hours. 

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

This notice describes how medical information about you may be used and disclosed and how you can get 

access to this information. Please review it carefully. This document may be updated without notice so

please review it each time you visit us. A copy of this statement is always available upon request.  All

information revealed by you in a counseling or therapy session and  most information placed in your counseling/

therapy file (all medical records  or other individually identifiable health information held or disclosed in any

form [electronic, paper, or oral]) is considered "protected health  information" by HIPAA. As such, your protected

health information cannot be distributed to anyone else without your express informed and voluntary written 

consent or authorization. 

The exceptions to this are defined immediately below. Additional information regarding your rights as a client can

be found in your therapist's/counselor's Professional Disclosure Statement and Consent for Treatment. Use or 

disclosure of the following protected health information does not require your consent or authorization:  

1. Uses and disclosures required by law like files court ordered by a Judge

2. Uses and disclosures about victims of abuse, neglect, or domestic violence like the Duties to Warn explained 

in your therapist's/counselor's Disclosure Statement

3. Uses and disclosures for health and oversight activities like correcting records or correcting records already

disclosed 

4. Uses and disclosures for judicial and administrative proceedings like a case where you are claiming 

malpractice or breech of ethics

5. Uses and disclosures for law enforcement purposes   like if you intend to harm someone else (see 

Duties to Warn in your therapist's/counselor's Disclosure Statement)

6. Uses and disclosures for research purposes like using client information in research; always maintaining 

client confidentiality 

7.Uses and disclosures to avert a serious threat to health or safety like calling Probate Court for a commitment 

hearing  

8. Uses and disclosures for Workman's Compensation-like the basic information obtained in counseling as a result

of your Workman's Compensation claim.

Your Rights as a Counseling/Therapy Client under HIPAA

1. As a client, you have the right to see your counseling/therapy file. Psychotherapy notes are excluded from 

this right per HIPPA regulations.

2. As a client, you have the right to receive a copy of your counseling/therapy file.  This file copy will consist

of only documents generated by us. You will be charged copying fees at $.10/page. Psychotherapy notes are 

not included under the HIPPA regulations.

3. As a client, you have the right to request amendments to your counseling file.

4. As a client, you have the right to receive a history of all disclosures of protected health at $.10/page.

5. As a client, you have the right to restrict the use and disclosure of your HIPPA information for the purposed 

of treatment, payment, and operations. If you chose to release any personal information you will be required 

to sign a release of information.

6. As a client, you have the right to register a complaint with the Secretary of Health and Human Services if 

you feel your rights, herein explained, have been violated. Prior to your counseling or therapy, you will receive 

1.) your HIPPA notice and rights as a counseling/therapy client under HIPPA 2.) your therapist's/counselor's 

Professional Disclosure Statement and Consent for Treatment-both for your personal records.  It will be necessary

for you to sign a certificate indicating that you have read and understand both documents. This certificate will 

be placed in your counseling file. If you do not understand anything about the documents, please do not sign

before asking questions.

It is customary to pay for professional services at the time they are rendered. The fee for individual or couples 

therapy is $150.00 per session. The initial evaluation fee is $175 per session.  Any other payment arrangements

or discounts will be discussed and agreed upon prior to your initial session. Be Still Counseling, LLC will request 

a credit, debit or HSA card be kept on file in our payment system and any fees will be charged after each session. 

If preferred, you can pay cash or check at the time of service.

Be Still Counseling, LLC values your time and in return expects the same. One late cancellation or no show will 

be allowed and after that all cancellations/no show made within 12 hours will be charged to your payment 

method on file at our full rate of $150.00 and cannot be billed to your insurance company. To be on the safe 

side attempt to make all cancellations within 24 hours.

By signing below I am stating that I acknowledge and agree to Be Still Counseling, LLC's fee schedule and late 

cancellation / no show policy and that a payment method will be kept on file.