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EVERYTHING IN YOUR CONSULT IS CONFIDENTIAL WITH THE EXCEPTION OF A REPORTED INTENT TO HARM SELF, ANOTHER, OR IF WE BECOME AWARE THAT A CHILD/ELDER/DEPENDENT IS POSSIBLY BEING HARMED. CHECK TO SIGNIFY UNDERSTANDING. I understand that Ashley Waknine Counseling & Coaching is an out-of-network provider, but I can request a Superbill from my clinician to submit to my insurance company for possible reimbursement.