Sample Forms and Templates

Consistent with the 2017 Code of Professional Ethics for Rehabilitation Counselors, the use of professional disclosure forms are required. Specifically, Standard A.3.a states, "Rehabilitation counselors review with clients, both orally and in writing, the rights and responsibilities of both the rehabilitation counselor and client. These are presented in a manner best suited to the needs of the client. The Standard further describes issues that should, at a minimum, be included.

CRCC offers sample professional disclosure forms and release statements, however, the forms below require review for applicability and modifications must be made as appropriate. Revisions for releases may also be required based on various laws or based on HIPAA requirements for transfer of medical records.

PROFESSIONAL Disclosure Form - Private Sector EXAMPLE - Forensic

View or Print Forensic Disclosure Form

PROFESSIONAL Disclosure Form - Private Sector EXAMPLE - Workers’ Comp/LTD

View or Print Workers’ Comp/LTD Disclosure Form

PROFESSIONAL Disclosure Form - Public Sector EXAMPLE

View or Print Public Sector Disclosure Form

Technology, social media, and Distance Counseling considerations

View or Print Technology, Social Media, and Distance Counseling Considerations


View or Print Consent to Release or Obtain Information