Dear New Client:

I am pleased to have the opportunity to provide professional clinical services to you today. In order to acquaint you with our organization, services and with me, I have provided you with several forms to read which explain my practice, our organization, fees and other important information . These forms explain our procedures to you and tell you about me and my professional services.

I would appreciate your taking time to initial the end page of the New Patient Handbook forms and then emailing the New Patient Forms to me as soon as possible. Completing these forms will allow me to begin providing my professional services without delay. These forms are required as a part of your clinical record and must be completed. IF THE PATIENT IS A MINOR OR IS UNABLE TO SIGN THESE FORMS, A PARENT OR GUARDIAN MUST SIGN FOR THEM.

If this is the first time that you have ever been to a professional Counselor, you will find that the information contained in the Professional Disclosure Statement and the Practice Disclosure Statement will be helpful to you in increasing your under-standing of our profession and how I will assist you. Please feel free to discuss any of the information contained in this New Patient Handbook with me at your convenience. I will be happy to answer any questions that you might have regarding these forms or their completion as a part of the New Patient registration process.

I look forward to meeting with you and assisting you to resolve the issues for which you have sought my assistance.

Sincerely,

John A. Garlock, Ed.D., Ph.D., LPC, LMFT, LCDC, CEAP, ADC III
Owner and Clinical Director
The Family Resource Center

Professional Disclosure Statement Of John Garlock, Ph.D., LPC, LMFT, LCDC, CEAP

The following information outlines the training, qualifications and experience of Dr. John Garlock. Additional information can be obtained by visiting our website at: www.helptochange.com and reviewing the "Who We Are" page which has a link to Dr. Garlock's Vita which lists additional information which may be of interest to you. The information listed below regarding Dr. Garlock is as follows:

EDUCATION

Dr. John Garlock has earned and been awarded the following college degrees:

Dr. Garlock has earned the following licenses and/or certifications:

Licensed Professional Counselor (LPC 737); Licensed Chemical Dependency Counselor(LCDC 1646); Licensed Marriage and Family Therapist (LMFT 00595-000589);Alcohol and Drug Counselor III Diplomate (ADC III); Certified Alcoholism and Drug Abuse Counselor (6150-0987); Certified Employee Assistance Professional (CEAP); Certified Eating Disorders Specialist (Number 103); National Certified Addictions Counselor (Number 009094); National Certified Counselor (NCC 4235); Certified Trauma Resolution Therapist, He is a member of The American Association of Christian Counselors (AACC).

GENERAL PRACTICE INFORMATION AND SPECIALIZATIONS

Dr. Garlock has the required training and experience and certifications/licenses to
practice with all age groups and a general range of presenting concerns/problems. He specializes in providing diagnostic evaluations and related counseling services to clients experiencing AD/HD, mood disorders, eating disorders, trauma, grief and loss, martial and family therapy, relationshipcounseling, anxiety disorders, alcohol and drug addiction education and relapse prevention needs and critical incident trauma survivors.

PROFESSIONAL EXPERIENCE

Dr. Garlock has seven years of administrative experience, sixteen years of outpatient counseling experience and ten years of inpatient psychiatric counseling experience. These experiences include all age groups and diagnostic categories. Dr. Garlock has been in practice for sixteen years with ten years at The Family Resource Center.

PROFESSIONAL PHILOSOPHY

Dr. Garlock's philosophy of treatment is client based, eclectic and solution oriented and he utilizes varied treatment approaches depending upon the presenting concerns and needs of the client. He believes in the importance of a quality focused personalized diagnostic assessment, when deemed appropriate, to assist in the diagnosis and treatment planning process. Each client treated by Dr. Garlock will have an individualized treatment plan completed during the first or second session which will be signed by the client and serves as the initial treatment plan agreement. This treatment plan will be updated as treatment progresses. Dr. Garlock believes in brief solution oriented therapy approaches which are problem related. Dr. Garlock also believes in the use of 12 step programs and other self help programs to assist in issue resolution whenever possible. Dr. Garlock believes that clients assume the primary responsibility in the resolution of their issues. He provides combined educational, insight oriented, systemic and behavioral treatment methodologies to assist clients to resolve their presenting issues. Whenever possible, Dr. Garlock will include significant others or family members in the treatment process.

Dr. Garlock believes in the "disease model" of chemical dependency and believes that a blended model of treatment is most appropriate in treating chemical dependency including clinical therapies, primary treatment, relapse prevention therapy, 12 step (A.A.) self help groups and SMART Recovery Group attendance and abstinence from mood altering chemicals. Dr. Garlock also believes in referring clients for specialized services such as medication evaluations and neurological and medical examinations, when it is appropriate to do so. When treating children and adolescents, Dr. Garlock utilizes combined behavioral and systems treatment approaches to resolve presenting issues. He also believes that diagnostic assessment is important in the development of a treatment plan for children and adolescents. Dr. Garlock does acknowledge that there are certain hazards to participating in counseling services that each client should be aware of. Among these potential hazards is the issue that some clients may get more symptomatic before they experience symptom diminishment and/or improvement. Some clients may not evidence symptom resolution through the treatment process. Some clients may possibly only learn how to live with their symptoms more effectively. There can be no guarantees about the outcome of the service delivery process. We do want to assure you that we will make every attempt to provide counseling services that are effective, brief and solution focused in order to gain the maximum benefit for you from the therapy process.

PROFESSIONAL AFFILIATIONS

Dr. Garlock is on the Allied Health Professional Staff of Intracare North Hospital. He does provide on site consultation services to various hospitals and companies as requested. Finally, he is half owner of the Processing and Cognitive Enhancement (PACE) Program which is a non-medical oriented treatment program for AD/HD and learning disorders for children and adolescents.

ORGANIZATIONAL INFORMATION

Dr. Garlock owns and operates The Family Resource Center which is a for profit business. He is also the Clinical Director of The Family Resource Center. He has one affiliate independent psychotherapist contractor, Mr. Art Albracht, M.Ed., LPC, who works with him at The Family Resource Center. Other mental health professionals utilize our office space on an as needed basis. The Family Resource Center has three convenient locations to serve you. These locations are as follows:

14300 Cornerstone Village Drive
Suite 227
Houston, Texas
77014

25100 Pitkin Lane
Suite 84A
The Woodlands, Tx
77386

1406 Stonehollow Place
Suite300
Kingwood, Tx
77339

Office Hours Information

On Mondays, Dr. Garlock provides he has office hours at his Cornerstone Village location from 9:00am through 8:15pm. On Tuesdays, he has office hours at his Cornerstone Village Drive location between the hours of 9:00am and 12:00pm. He then has office hours at his Woodlands location from 1:30pm through 9:00pm. On Wednesdays, he has office hours at his Cornerstone Village Drive office location from 9:00am through 8:15 pm. On Thursdays, he has office hours at his Kingwood location all day from 9:00am through 8:15pm. On Fridays, he has office hours from 10:00am through 7:30pm at his Kingwood office location. On Saturdays, he has office hours at his Woodlands location from 9:00am through 6:00pm. All of these office hours are by appointment. He is unable to take walk in clients due to the nature and structure of his appointment schedule.

INTERNET INFORMATION AND SERVICES

Dr. Garlock has a full service web site which provide information for clients which are easily accessible. This web site url is as follows:

www.helptochange.com

Clients can get new client information, get maps to our locations, request appointment times and order self help programs and learn more about our services from these web sites. Please take the time to visit our web sites. Dr. Garlock also has bulletin boards and a chat room. Our newsletter is located at www.frnewsletter.com . To reach Dr. Garlock via his email address, send emails to: jagvw@earthlink.net

HELP TO CHANGE. COM WEB SITE

Our primary web site: www.helptochange.com offers you a lot of information and services that you can use at any time without any cost to you. Among the features of our practice web site are the following:

Mini Downloadable "Free Help" Programs
Questions And Answers To Life's Problems
Self Help Topics Information And Related Web Sites
New Client Registration Forms
On Line Clinical Form Completion And Form Downloading
On Line Appointment Time Requests
On Line Newsletter Subscription And Link To Newsletter
Self Help Product Bookstore
Links To Sites Featuring Dr. Garlock
On Line Bulletin Board For Messaging And Information
Email Program For Information From Dr. Garlock
Office Locations And Maps To Offices
Dr. Garlock's Vita And Experience And Qualifications

New information and features are being added to our web site all the time. If you have an idea for a new feature or information resource that you would like to have added to our practice web site, please let Dr. Garlock know so that he can consider your request.

OUR PRACTICE NEWSLETTER

We are pleased to offer our Family Resource News newsletter to the clients of our practice. This newsletter features articles about various self help topics, our web site features, our upcoming programs and seminars and other helpful topics which our clients request. The url for this is www.frnewsletter.com and we invite you to visit this web site which is the site for our practice newsletter. We issue the newsletter on the first day of each month and you can view it on the url, download it with Microsoft Word, or print it out on your printer. We also welcome any suggestions that you might have for future newsletter topics.

LICENSING INFORMATION

Dr. Garlock is a Licensed Professional Counselor (LPC) and operates independently in private practice. He is subject to The Code Of Ethics of the Texas State Board of Examiners Of Professional Counselors. Dr. Garlock provides quality mental health treatment services to his clients and is genuinely concerned about your welfare. If, for any reason, you are not satisfied with his services, please let him know of your dissatisfaction. If, in doing so, you do not obtain a satisfactory resolution with Dr. Garlock, you may direct complaints against Dr. Garlock to the Texas State Board of Examiners of Professional Counselors by calling (512) 834-6658.

Dr. Garlock is a Licensed Marriage and Family Therapist (LMFT) and operates independently in private practice. He is subject to the Code Of Ethics of the Texas State Board of Examiners Of Marriage and Family Therapists. Dr. Garlock provides quality marital and family therapy services to his clients and is genuinely concerned about your welfare. If, for any reason, you are dissatisfied with his professional services, please let Dr. Garlock know of your dissatisfaction. If you do not obtain a satisfactory resolution with Dr. Garlock, you may direct complaints against Dr. Garlock to the Texas State Board of Examiners of Marriage and Family Therapists by calling (800) 942-5540.

Dr. Garlock is a Licensed Chemical Dependency Counselor (LCDC) and operates independently in private practice. He is subject to the Code Of Ethics of the Texas Commission On Alcohol And Drug Abuse. Dr. Garlock provides quality evaluations and chemical dependency counseling and related services to his clients and is genuinely concerned about your welfare. If, for any reason, you are dissatisfied with his professional services, please let Dr. Garlock know of your dissatisfaction. If you
do not obtain a satisfactory resolution with Dr. Garlock, you may direct complaints against Dr. Garlock to the Texas Commission On Alcohol And Drug Abuse by calling (800) 832-9623.

ADDITIONAL INFORMATION

Dr. Garlock does not provide expert witness Court testimony and does not provide his professional services in child custody proceedings. If you are required to attend therapy by an outside source such as a Court to satisfy a legal ruling, these services often are not covered by your insurance company. You will have to check with your insurance company to determine if they will reimburse Dr. Garlock for your clinical services prior to seeing Dr. Garlock for your initial appointment. Then, Dr. Garlock will determine if he will be able to provide professional services to you as required by the Court proceedings. In the State Of Texas, the Courts recognize Licensed Psychologists and Psychiatrists (Medical Doctors) as experts in Court proceedings. The same is true for disability cases.

Dr. Garlock does not provide Court testimony in divorce or adoption or custody proceedings. He does not do depositions or other legal proceedings about information contained in your records. If you require these services, please notify Dr. Garlock and he will refer you to a qualified clinician who does provide these types of services. Dr. Garlock also does not do parenting evaluations for Court proceedings.

Dr. Garlock does not permit electronic monitoring or reproduction of any clinical services that he provides. Tape recording of sessions is prohibited. In addition, electronic recording of telephone conversations with Dr. Garlock, without his permission, is prohibited.

MISSED APPOINTMENT POLICY

We have a "Missed Appointment Policy" that we request that all clients follow while receiving services from us. Please contact us immediately when you know that you will have to miss your scheduled appointment with Dr. Garlock. We reserve your appointment time specifically for you and appreciate your using our services. If you do not notify us 24 hours in advance of your missed scheduled appointment time, you will be responsible for paying the full session cost. If you cancel over 24 hours before your scheduled appointment time, you will not be billed for the session cost. If you miss 2 appointments in a row without contacting us, we will close your case administratively and you will not longer be a client in our practice.

NEW CLIENT ELECTIONIC INFORMATION TRANSMISSION POLICY

I authorize Dr. John Garlock, LPC, to electronically transmit information to me about his practice, services, products and web sites. I also give permission for him to email me his free monthly Family Resource Center Newsletter and other information about his for fee products that he has developed and is offering for sale through his practice. I do under-stand that I am under no obligation to purchase any products that he offers for sale.

I also understand that I can email Dr. Garlock at any time and request that I be taken off of his email newsletter list. Please initial the last page to give permission for Dr. Garlock to send you this information. If you desire not to have this information sent to you, please let Dr. Garlock know when you next have contact with him..