Professional Disclosure Statement

Qualifications

My name is Sarah Johnson, and I am a Limited Licensed Professional Counselor (LLPC) in the state of Michigan. I earned a Bachelor of Arts in Business Administration from Alma College in 2010 and a Master of Arts in Counseling from Wake Forest University in May 2026.

I provided counseling services under professional supervision as required for licensure in Michigan.

My clinical supervision is provided through Mosaic Counseling by:

• Ashley McCormick, LMAC
• Sarah Lewakowski, MA, LLP

In addition, I receive academic supervision through Wake Forest University from Dr. Sharon Jones.

As part of the supervision process, supervisors may review case notes or recordings of counseling sessions to support training and ensure quality care. Recordings will only occur with your written consent and will be used strictly for supervision purposes.

Counseling Background

I work with clients across the lifespan and support individuals experiencing a variety of concerns including anxiety, depression, interpersonal and relationship concerns, family conflict, parenting challenges, couple’s issues, divorce recovery, stress management, eating disorders, life transitions, self-esteem concerns, bullying and peer conflict, trauma, and grief and loss.

My approach to counseling is grounded in a person-centered perspective, meaning I believe each individual holds the capacity for growth, insight, and meaningful change. I strive to create a supportive and collaborative environment where clients feel safe exploring their experiences and working toward their goals.

Depending on the needs of the client, I may incorporate techniques from several evidence-based approaches including:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavior Therapy (DBT)
• Motivational Interviewing
• Narrative Therapy

Scheduling, Session Fees and Length of Service

The initial counseling session typically involves a comprehensive intake assessment lasting approximately 60 minutes. During this session we will review your history, discuss current concerns, and identify goals for counseling.

Subsequent counseling sessions are generally 53 minutes in length.

Counseling services provided by graduate interns at Mosaic Counseling are offered on a sliding-scale fee structure, which is determined during the intake process. Payment policies and accepted payment methods are determined by Mosaic Counseling. Questions regarding billing or payment may be directed to Mosaic Counseling at (616) 842-9160.

If you need to cancel or reschedule an appointment, please provide at least 24 hours’ notice when possible. Missed appointments or late cancellations will not be subject to a fee, but 24-hour notification of cancellation is required according to Mosaic Counseling’s policies.

My counseling style is warm, down-to-earth, and collaborative, guided by empathy, curiosity, and a commitment to helping clients better understand themselves and move toward meaningful change.

Use of Diagnosis

Some health insurance companies reimburse clients for counseling services, while others do not. Many insurance providers require that a mental health diagnosis be assigned before counseling services can be reimbursed.

If insurance reimbursement is sought, a diagnosis may be required and submitted to the insurance provider. You will be informed of any diagnosis prior to submission. Please note that diagnoses submitted to insurance companies become part of your permanent insurance record.

Some concerns that bring individuals to counseling may not meet criteria for a formal diagnosis. In those cases, alternative payment arrangements may be discussed.

Confidentiality

Information shared during counseling sessions will be kept confidential. However, there are certain circumstances in which confidentiality must be broken in accordance with ethical and legal standards.

Confidentiality may be limited if:

• You provide written consent for information to be shared
• There is reason to believe you may be a danger to yourself or others
• There is suspected abuse or neglect of a child, elder, or vulnerable adult
• Records are ordered to be released by a court of law

Michigan law requires counselors to report suspected child abuse or neglect to Child Protective Services.

Because I am a counseling intern, aspects of our sessions may be discussed with my supervisors for consultation and training purposes. Supervisors are bound by the same standards of confidentiality and professional ethics.

Note: Email and phone communication should be used primarily for scheduling purposes. Please avoid sharing sensitive personal information through email, as confidentiality cannot be fully guaranteed through electronic communication.

Emergencies

If you experience a mental health emergency outside of scheduled counseling sessions, please seek immediate help through one of the following options:

• Call 911 or go to the nearest emergency room.
• 988 Suicide and Crisis Lifeline — Dial 988
• Crisis Text Line — Text HOME to 741741
• Trevor Project (LGBTQ Youth) — 866-488-7386

Local resources:

• Holland Hospital Behavioral Health — 602 Michigan Ave, Holland, MI · (616) 392-5141
• Pine Rest Urgent Care — 300 68th St SE, Building E, Grand Rapids, MI · (616) 455-5490

Ending Therapy

The goal of counseling is to support clients in reaching a point where therapy is no longer necessary. The length of counseling varies depending on each individual’s needs and goals.

As a client, you have the right to ask questions about the counseling process, participate actively in treatment decisions, request referrals, and review your records as permitted by law. You are also free to discontinue counseling at any time. If counseling ends due to the completion of my internship or for another reason, Mosaic Counseling will assist with transitioning care to another provider if needed.

Client-Consumer Rights, Complaints

If you have concerns regarding your counseling services, you are encouraged to discuss them with me so that we may work toward a resolution.

You may also file a complaint with the following organization:

Michigan Department of Licensing and Regulatory Affairs (LARA)
Bureau of Professional Licensing
P.O. Box 30670, Lansing, MI 48909
Phone: 517-241-0205
Website: www.michigan.gov/healthlicense

I adhere to the ethical standards outlined in the American Counseling Association (ACA) Code of Ethics.

Acceptance of Terms

Please sign below to acknowledge that you have received and reviewed this Professional Disclosure Statement and understand the information it contains.

“We agree to these terms and will abide by its guidelines.”

Client Name: ______________________________
Client Signature: __________________________   Date: __________
Counselor Signature: _______________________   Date: __________

Sincerely,
Sarah Johnson
Limited Licensed Professional Counselor (LLPC)
Mosaic Counseling
Office: 616-842-9160
internc@mosaiccounseling.com