LONE STAR COUNSELING SOLUTIONS

BROOK ZEMEL, PH.D., LPC-S

COUNSELING INTAKE FORM

Note: This information is confidential.
Demographic Information:
Name: Date:
Age: Date of Birth
Relationship Status:   Single    Partner  Married  Seperated   Cohabitating  Divorced Widow 
# of Dependents: Gender:   Male    Female 
# Home/Mobile Phone:
Is it ok to leave a message for you at this number? :     Yes    No 
Work Phone:
Is it ok to leave a message for you at this number?     Yes    No 
Mailing Address:
E-mail Address: Skype Name:
Current Employer: Position Title:
Current Occupational Status: (i.e., F/T, P/T, self-employed, student, returning to work): 
How long on this Job: Do you enjoy your job?   Yes    No 
Education Level: Special Trainings:
Medical Doctor's Name/Phone: Psychiatrist's Name/Phone:
Emergency Contact Name:
ER Contact Relationship: Emergency Contact Phone:
How were you referred?: If online, which website?
1. PLEASE DESCRIBE YOUR REASON(S) FOR SEEKING TREATMENT AT THIS TIME (CARE). IF THERE IS A PARTICULAR EVENT WHICH TRIGGERED YOUR DECISION TO SEEK TREATMENT NOW, PLEASE LIST THE EVENT.
WHAT RESULT(S) DO YOU EXPECT FROM COUNSELING (LIST 2 OR 3 GOALS)?
2. Behavior - circle/highlight any of the following behaviors that apply to you:
Overeat Insomnia Suicidal attempts Vomiting Can't keep a job Smoke
Take drugs Take too many risks Compulsions Odd behavior Withdrawal Work too hard
Lack of motivation Procrastination Drink too much Sleep disturbance Nervous tics Crying
Eating problems Impulsive reactions
Phobic avoidance Outbursts of temper Loss of control
Aggressive behavior Concentration difficulties
Are there any specific behaviors, actions, habits that you would like to change?
3. Feelings - circle/highlight any of the following feelings that apply to you:
Angry Guilty Unhappy Annoyed Happy
Bored Sad Conflicted Restless Depressed
Lonely Anxious Hopeless Contented Fearful
Hopeful Excited Panicky Helpless Optimistic
Energetic Relaxed Tense Envious Jealous
Others
4. CHECK ALL THAT APPLY TO YOU:
  Never Rarely Frequently Very Often   Never Rarely Frequently Very Often
Marijuana Heart problems
Tranquilizers Nausea
Sedatives Vomiting
Aspirin Insomnia
Cocaine Headaches
Painkillers Backaches
Alcohol Early morning awakening
Coffee Fitful sleep
Cigarettes Binge / Purge
Narcotics Poor appetite
Stimulants Eat "junk foods"
Hallucinogens Lack of interest in activities
Diarrhea Constipation
Compulsive Exercise High blood pressure
Use Laxatives Allergies
5. Physical - circle/highlight any of the following symptoms that apply to you:
Headaches Stomach trouble Skin problems
Dizziness Dry mouth Tics
Palpitations Fatigue Burning or itchy skin
Muscle spasms Twitches Chest pains
Tension Back pain Rapid heart beat
Sexual disturbances Tremors Unable to relax
Fainting spells Blackouts Bowel
Hear things Excessive sweating Tingling
Watery eyes Visual disturbances Numbness
Flushes Hearing problems Don't like being touched
Do you regularly exercise: What:  
How Often:  
6. HAVE YOU EVER HAD COUNSELING OR MENTAL HEALTH TREATMENT BEFORE?     Yes    No 
Reason: 
Outcome: 
7. PLEASE LIST ANY MEDICATIONS YOU ARE CURRENTLY TAKING INCLUDING OVER THE COUNTER MEDICATIONS.
TREATMENT PHILOSOPHY
I BELIEVE IN WORKING TOGETHER TO ASSIST YOU IN MAKING THE CHANGES YOU FEEL ARE NECESSARY IN YOUR LIFE.
TOGETHER, WE WILL GATHER THE USEFUL INFORMATION NECESSARY FOR ME TO ASSIST YOU IN MAKING THESE CHANGES. WE WILL WORK TOGETHER, AS A TEAM, TO ATTAIN THE GOALS YOU SET FOR YOURSELF.
PAYMENT CONTRACT FOR LONE STAR COUNSELING SOLUTIONS
The following is a statement of the financial policy. It is requested that you read and sign this statement prior to beginning services. Full payment is due at time of service. Payment methods include: Check, Cash, PayPal, Visa/MC/Discover/Amex. A fee will be assessed to your account for all returned checks. Clients using charge cards sign below allowing the provider to automatically submit charges to the charge card after each session and can change payment information at any time.

FEDERAL TRUTH IN LENDING DISCLOSURE STATEMENT FOR PROFESSIONAL SERVICES

Part One     Fees for Professional Services
$110 is charged per in-person (IP) session and per Skype (S) session (each defined as 60 minutes)
$110 (IP) or (S) is charged for missed appointments or cancellations with less than 24 hours notice.
$27.50 (IP) or $22.50 (S) is charged for extended email/phone communication in 15 minute increments.
$95 fee for 2 assessments with detailed analysis.
Note: $20 discounts are offered for Skype sessions (see website for details).
I also take Blue Cross Blue Shield of Texas. Clients are responsible for co-pays and possibly costs associated with their deductible/co-insurance at each session. It is imperative that you check with your insurance company to determine what your costs will be.

Part Two     All Clients
Payments, testing/assessment fees, and related fees are due at the time of service. Services will be terminated if timely payment is not made as agreed to by this consent.

Part Three     Minors
The adult accompanying a minor (or guardian of the minor) is responsible for payments for the child at the time of service.


I HEREBY CERTIFY that I have read and agree to the above terms and conditions and accept full responsibility for payment of all fees at the time of the visit, unless other arrangements have been made.
Client's Name:                                       DOB: 
Person responsible for account              Date:  

Informed Consent for Counseling Lone Star Counseling Solutions; Brook Zemel, Ph.D., LPC-S

I am licensed by the Texas Board of Examiners of Professional Counselors and am considered a Licensed Professional Counselor or L.P.C. In addition, I am an approved supervisor (LPC-S) of LPC- Interns (LPC-I). I received a Ph.D. in Counseling from Washington State University. I also have a Master of Science Degree in Education with a major in counseling from Indiana University- Bloomington. My training qualifies me to offer individual, couples, relationship, and/or group counseling. Sometimes, family sessions are utilized during treatment as well. If our work together indicates that there are issues beyond my personal expertise, I will refer you to an appropriate practitioner that may better provide necessary services.
Goals of Counseling: Counseling is a joint effort between the counselor and client, the results of which cannot be guaranteed. Progress depends on many factors including: motivation, effort, and other life circumstances such as interactions with family, friends and other associates. Electronic Transmission: I cannot ensure the confidentiality of any form of communication through electronic media. By law, E-mail correspondence is not considered to be a confidential medium of communication.
Records: I am required to maintain records of my work with you. These generally take the form of notes that I make during and after appointments, intake information, written information that you give me, billing information and correspondence. These records will not be released without your written consent, except in situations described under the page Limits of Confidentiality.
CLIENT RIGHTS: You have the right to inquire about my professional credentialing and experience as a counselor. You have the right to refuse a particular recommendation. You have the right to discuss concerns or dissatisfactions about our work together. You also have the right to end counseling at any time. (I do, however, encourage you to make a commitment to attend a final session before terminating). For violations of the Texas Administrative Code, contact: Texas State Board of Professional Counselors, Complaints Management and Investigative Section, P.O. Box 141369, Austin, Texas 78714-1369 or call 1-800-942-5540.
Cancellations and Missed Appointments: When you schedule an appointment, that hour is reserved expressly for you, therefore, if you fail to inform me at least 24 hours in advance, you will be billed at your normal fee. If you decide to terminate services, please let me know. If you fail to attend two consecutive sessions without notifying me, I will assume that you wish to terminate services. Billing Practices: Payment for services is expected at the time of service. Whether you file insurance or not you are responsible for full payment for services rendered, so if an insurance company denies payment, you are still responsible for the allotted amount of payment. It is very important that you check with your insurance company immediately prior to the time of service to verify coverage, deductibles and co-pays.
Fees: My standard fee for a 60 minute session is $110.00 (IP) or $90 (S), with the exception of approved insurance companies and contracted fees for services from those companies. In the instance where assessments are used, there is a $75.00 fee for 2 assessments with a detailed analysis. Note: I accept cash, personal checks PayPal, and credit cards (see Payment Contract). Delinquent Accounts: There is a $25 service charge for returned checks. Your name may be released to a collection agent if your account becomes delinquent. I will work with you in every possible way to avoid such an event.
AFTER HOURS EMERGENCIES: Emergency situations may necessitate immediate attention. Situations can escalate and become quickly unmanageable. If an emergency situation for which the client or their guardian feels immediate attention is necessary, the client or guardian understands that they are to contact emergency services, their physician or psychiatrist, or go immediately to the nearest emergency room. You may also call 911. Emergencies are urgent issues requiring immediate action. I will follow those emergency services with standard counseling and support to the client or clien's family.
LIMITS OF CONFIDENTIALITY: All information shared will be kept confidential with the following exceptions: (a) you give me written permission to tell someone else, and I agree to do so; (b) I believe you are a danger to yourself or others; (c) you disclose a minor is being exposed to or is consuming substances that are potentially harmful; (d) you disclose abuse, neglect or exploitation of a child, elderly person or disabled individual; (e) in a previous counseling/therapeutic relationship, your counselor sexually exploited you; (f) for verification of insurance benefits and billing purposes; (g) if I receive a court subpoena for your records (h) if you are a minor (under age 18), your parents or legal guardians can have access to your records; and/or (i) you disclose prenatal exposure to controlled substances that are potentially harmful.
Insurance Providers (when applicable): Insurance companies and other third-party payers are given information that they request regarding services to clients. Information that may be requested includes, but is not limited to: types of service, dates/times of service, diagnosis, treatment plan, description of the impairment, progress of therapy, case notes, and summaries.

I agree to the above limits of confidentiality and understand their meanings and ramifications. I have read, understood, agree, and consent to the above conditions of service stated. I have also received the Notice of Privacy Practices on this date. I recognize that I have the opportunity now, and in the future, to discuss any questions I may have with Dr. Zemel.

Client Signature (Client's Parent/Guardian if under 18): 
Today's Date: 
 

NOTICE OF PRIVACY PRACTICES - LONE STAR COUNSELING SOLUTIONS

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.
I am required by applicable federal and state law to maintain the privacy of your health information and inform you of my privacy practices, legal obligations, and your rights concerning your health information. I must follow the privacy practices that are described in this Notice (which may be amended from time to time).
I am required to abide by the terms of the Notice of Privacy Practices that is most current. I reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that I maintain. The revised Notice will be posted in the waiting room. You may request a copy of the revised Notice at any time.
I will answer your questions about my privacy practices and do ensure that I will comply with applicable laws and regulations. I will also take your complaints and can give you information about how to file a complaint.
I. USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION THAT MAY BE MADE TO CARRY OUT HEALTHCARE OPERATIONS.
I may use and disclose limited information from your record without your written authorization, excluding Counseling Notes as described in Section IV, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.
Treatment: I may use and disclose limited information in order to provide treatment to you. For example, I may use information to diagnose and provide counseling service to you. In addition, I may disclose information to other health care providers involved in your treatment.
Payment: I may use or disclose limited information from your record to obtain payment for the services you receive. For example, I may submit your diagnosis with a health insurance claim in order to demonstrate to the insurer that the service should be covered.
Health Care Operations: I may use and disclose information (not your name or other identifying information) from your record to allow health care operations including quality improvement activities, intern training programs, reviewing records to see how care can be improved, accreditation, certification, licensing or credentialing activities. For example, I may use information in your record to train another counselor.
II. YOUR INDIVIDUAL RIGHTS
Right to Inspect and Copy. You may request access to the information in your record maintained by me in order to inspect and make a copy of it. All requests for access must be made in writing. Under limited circumstances, I may deny access to your records. I may charge a fee for the costs of copying and sending you any records requested.
Right to Request Restrictions. You may ask to restrict the use and disclosure of certain information in your record that otherwise would be allowed for treatment or payment. You must request any such restriction in writing. I am not required to agree to any such restriction you may request. Right to Accounting of Disclosures. You have the right to request an accounting of any disclosures made by me.
Right to Request Amendment: If you believe information in your record is inaccurate or incomplete, you may request amendment of the information. You must submit sufficient information to support your request for amendment. Your request must be in writing, and it must explain why the information should be amended. I may deny your request under certain circumstances.
Right to Obtain Notice. You have a right to obtain a paper copy of this Notice upon request. Right to Complain. You have the right to complain to us about our privacy. You have the right to complain to the Secretary of the Department of Health and Human Services about our privacy practices. You will not face retaliation from us for making complaints.
Except as described in this Notice, I may not make any use or disclosure of information from your record unless you give me your written authorization. You may revoke an authorization in writing at any time, but this will not affect any use or disclosure made by us before the revocation. In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer may have the right to contest the policy or a claim under the policy even if you revoke the authorization.
III. USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION THAT I AM REQUIRED TO MAKE WITHOUT YOUR PERMISSION.
Communications between a counselor and client are privileged and may not be disclosed without your permission, except as required by law. For example, counselors must report suspected abuse/neglect of a child, elder, or disabled person. I may have to breach confidentiality if you appear to post an imminent danger to yourself or others, in order to reduce the likelihood of harm to you or others. Also, I must disclose information to the Department of Health and Human Services, if requested, to prove that I am complying with regulations that safeguard your health information.
I may disclose information from your record if ordered to do so by a court, grand jury, or administrative tribunal. Under certain conditions, I may disclose information in response to a subpoena or other legal process, even without a court order.
You have a right to receive confidential communications from me. For example, if you want to receive bills and other information at an alternative address, please notify me. I may contact you to provide information or appointment reminders as a courtesy. Please notify me if I am not to leave a telephone message or use electronic communication. You are responsible for remembering your appointment, whether or not you receive a reminder.
I may contact you with information about treatment alternatives or other health-related benefits or services that may be of interest to you.

By signing this Policy and Procedures form, I, the undersigned client, acknowledge that I have read and understand all the terms and information contained herein; that I have received a copy of the Notice of Privacy Practices and that ample opportunity has been offered to me to ask questions and seek clarification.
Client/ Parent: 

Date: 
 
 
 
 
    

User Rating:  / 0

RELEASE OF INFORMATION AND CONSULTATION
LONE STAR COUNSELING SOLUTIONS

BROOK ZEMEL, PH.D., LPC-S

281-703-7400

920 E. BLANCO, STE. B, BOERNE, TEXAS, 78006

BROOK@LONESTARCOUNSELINGSOLUTIONS.COM


I have informed (any additional therapist)Dr./Mr./Ms.: , address: , phone: and they have approved my meeting with Brook Zemel, Ph.D., LPC-S to receive counseling services. I give permission to Brook Zemel, Ph.D., LPC-S to speak with and receive records from Dr./Mr./Ms. for the purpose of giving and receiving information for coordination of my treatment.

Client's printed first name:
Client's printed last name:
Client's signature:

Date:
    

User Rating:  / 0

Do you take insurance for psychotherapy appointments?

Yes, I have been approved by Blue Cross Blue Shield of Texas as an in-network provider. It is extremely important that you contact your insurance company, by calling the number on the back of your card, for mental health or behavioral health services. Be sure to ask about the reimbursement process, and if you need a pre-authorization code for your sessions (some plans won't reimburse without it). Find out if there are specific forms you need to submit to get your sessions covered.

Some considerations when submitting insurance?

  • I believe strongly in protecting your privacy, but on an insurance panel, I do not have control of confidential information they need to approve your treatment.
  • Insurance companies require that I submit a diagnosis of a mental disorder in order to provide coverage. Clients who did not meet full criteria for a mental illness may be denied coverage, because it is not deemed "medically necessary."
  • Because the insurance company is paying part of your bill for psychotherapy, they are also entitled to information about your counseling sessions - the frequency, treatment plan, and other confidential details.
  • In order to contain their costs, they are also more actively trying to dictate the treatment plan and what they determine is "medically necessary" treatment.
User Rating:  / 0

Informed Consent for Counseling Lone Star Counseling Solutions; Brook Zemel, Ph.D., LPC-S

I am licensed by the Texas Board of Examiners of Professional Counselors and am considered a Licensed Professional Counselor or L.P.C. In addition, I am an approved supervisor (LPC-S) of LPC- Interns (LPC-I). I received a Ph.D. in Counseling from Washington State University. I also have a Master of Science Degree in Education with a major in counseling from Indiana University- Bloomington. My training qualifies me to offer individual, couples, relationship, and/or group counseling. Sometimes, family sessions are utilized during treatment as well. If our work together indicates that there are issues beyond my personal expertise, I will refer you to an appropriate practitioner that may better provide necessary services.
Goals of Counseling: Counseling is a joint effort between the counselor and client, the results of which cannot be guaranteed. Progress depends on many factors including: motivation, effort, and other life circumstances such as interactions with family, friends and other associates. Electronic Transmission: I cannot ensure the confidentiality of any form of communication through electronic media. By law, E-mail correspondence is not considered to be a confidential medium of communication.
Records: I am required to maintain records of my work with you. These generally take the form of notes that I make during and after appointments, intake information, written information that you give me, billing information and correspondence. These records will not be released without your written consent, except in situations described under the page Limits of Confidentiality.
CLIENT RIGHTS: You have the right to inquire about my professional credentialing and experience as a counselor. You have the right to refuse a particular recommendation. You have the right to discuss concerns or dissatisfactions about our work together. You also have the right to end counseling at any time. (I do, however, encourage you to make a commitment to attend a final session before terminating). For violations of the Texas Administrative Code, contact: Texas State Board of Professional Counselors, Complaints Management and Investigative Section, P.O. Box 141369, Austin, Texas 78714-1369 or call 1-800-942-5540.
Cancellations and Missed Appointments: When you schedule an appointment, that hour is reserved expressly for you, therefore, if you fail to inform me at least 24 hours in advance, you will be billed at your normal fee. If you decide to terminate services, please let me know. If you fail to attend two consecutive sessions without notifying me, I will assume that you wish to terminate services. Billing Practices: Payment for services is expected at the time of service. Whether you file insurance or not you are responsible for full payment for services rendered, so if an insurance company denies payment, you are still responsible for the allotted amount of payment. It is very important that you check with your insurance company immediately prior to the time of service to verify coverage, deductibles and co-pays.
Fees: My standard fee for a 60 minute session is 0.00 (IP) or (S), with the exception of approved insurance companies and contracted fees for services from those companies. In the instance where assessments are used, there is a .00 fee for 2 assessments with a detailed analysis. Note: I accept cash, personal checks PayPal, and credit cards (see Payment Contract). Delinquent Accounts: There is a service charge for returned checks. Your name may be released to a collection agent if your account becomes delinquent. I will work with you in every possible way to avoid such an event.
AFTER HOURS EMERGENCIES: Emergency situations may necessitate immediate attention. Situations can escalate and become quickly unmanageable. If an emergency situation for which the client or their guardian feels immediate attention is necessary, the client or guardian understands that they are to contact emergency services, their physician or psychiatrist, or go immediately to the nearest emergency room. You may also call 911. Emergencies are urgent issues requiring immediate action. I will follow those emergency services with standard counseling and support to the client or clien's family.
LIMITS OF CONFIDENTIALITY: All information shared will be kept confidential with the following exceptions: (a) you give me written permission to tell someone else, and I agree to do so; (b) I believe you are a danger to yourself or others; (c) you disclose a minor is being exposed to or is consuming substances that are potentially harmful; (d) you disclose abuse, neglect or exploitation of a child, elderly person or disabled individual; (e) in a previous counseling/therapeutic relationship, your counselor sexually exploited you; (f) for verification of insurance benefits and billing purposes; (g) if I receive a court subpoena for your records (h) if you are a minor (under age 18), your parents or legal guardians can have access to your records; and/or (i) you disclose prenatal exposure to controlled substances that are potentially harmful.
Insurance Providers (when applicable): Insurance companies and other third-party payers are given information that they request regarding services to clients. Information that may be requested includes, but is not limited to: types of service, dates/times of service, diagnosis, treatment plan, description of the impairment, progress of therapy, case notes, and summaries.

I agree to the above limits of confidentiality and understand their meanings and ramifications. I have read, understood, agree, and consent to the above conditions of service stated. I have also received the Notice of Privacy Practices on this date. I recognize that I have the opportunity now, and in the future, to discuss any questions I may have with Dr. Zemel.

Client Signature (Client's Parent/Guardian if under 18): 
Today's Date: 
 

NOTICE OF PRIVACY PRACTICES - LONE STAR COUNSELING SOLUTIONS

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.
I am required by applicable federal and state law to maintain the privacy of your health information and inform you of my privacy practices, legal obligations, and your rights concerning your health information. I must follow the privacy practices that are described in this Notice (which may be amended from time to time).
I am required to abide by the terms of the Notice of Privacy Practices that is most current. I reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that I maintain. The revised Notice will be posted in the waiting room. You may request a copy of the revised Notice at any time.
I will answer your questions about my privacy practices and do ensure that I will comply with applicable laws and regulations. I will also take your complaints and can give you information about how to file a complaint.
I. USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION THAT MAY BE MADE TO CARRY OUT HEALTHCARE OPERATIONS.
I may use and disclose limited information from your record without your written authorization, excluding Counseling Notes as described in Section IV, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.
Treatment: I may use and disclose limited information in order to provide treatment to you. For example, I may use information to diagnose and provide counseling service to you. In addition, I may disclose information to other health care providers involved in your treatment.
Payment: I may use or disclose limited information from your record to obtain payment for the services you receive. For example, I may submit your diagnosis with a health insurance claim in order to demonstrate to the insurer that the service should be covered.
Health Care Operations: I may use and disclose information (not your name or other identifying information) from your record to allow health care operations including quality improvement activities, intern training programs, reviewing records to see how care can be improved, accreditation, certification, licensing or credentialing activities. For example, I may use information in your record to train another counselor.
II. YOUR INDIVIDUAL RIGHTS
Right to Inspect and Copy. You may request access to the information in your record maintained by me in order to inspect and make a copy of it. All requests for access must be made in writing. Under limited circumstances, I may deny access to your records. I may charge a fee for the costs of copying and sending you any records requested.
Right to Request Restrictions. You may ask to restrict the use and disclosure of certain information in your record that otherwise would be allowed for treatment or payment. You must request any such restriction in writing. I am not required to agree to any such restriction you may request. Right to Accounting of Disclosures. You have the right to request an accounting of any disclosures made by me.
Right to Request Amendment: If you believe information in your record is inaccurate or incomplete, you may request amendment of the information. You must submit sufficient information to support your request for amendment. Your request must be in writing, and it must explain why the information should be amended. I may deny your request under certain circumstances.
Right to Obtain Notice. You have a right to obtain a paper copy of this Notice upon request. Right to Complain. You have the right to complain to us about our privacy. You have the right to complain to the Secretary of the Department of Health and Human Services about our privacy practices. You will not face retaliation from us for making complaints.
Except as described in this Notice, I may not make any use or disclosure of information from your record unless you give me your written authorization. You may revoke an authorization in writing at any time, but this will not affect any use or disclosure made by us before the revocation. In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer may have the right to contest the policy or a claim under the policy even if you revoke the authorization.
III. USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION THAT I AM REQUIRED TO MAKE WITHOUT YOUR PERMISSION.
Communications between a counselor and client are privileged and may not be disclosed without your permission, except as required by law. For example, counselors must report suspected abuse/neglect of a child, elder, or disabled person. I may have to breach confidentiality if you appear to post an imminent danger to yourself or others, in order to reduce the likelihood of harm to you or others. Also, I must disclose information to the Department of Health and Human Services, if requested, to prove that I am complying with regulations that safeguard your health information.
I may disclose information from your record if ordered to do so by a court, grand jury, or administrative tribunal. Under certain conditions, I may disclose information in response to a subpoena or other legal process, even without a court order.
You have a right to receive confidential communications from me. For example, if you want to receive bills and other information at an alternative address, please notify me. I may contact you to provide information or appointment reminders as a courtesy. Please notify me if I am not to leave a telephone message or use electronic communication. You are responsible for remembering your appointment, whether or not you receive a reminder.
I may contact you with information about treatment alternatives or other health-related benefits or services that may be of interest to you.

By signing this Policy and Procedures form, I, the undersigned client, acknowledge that I have read and understand all the terms and information contained herein; that I have received a copy of the Notice of Privacy Practices and that ample opportunity has been offered to me to ask questions and seek clarification.
Client/ Parent: 

Date: 
 
 
As witnessed by:   Date:  
 
 
    

User Rating:  / 0

Skype/Online Counseling

Skype/Online Counseling is not for everybody, nor is it appropriate for some personal and emotional issues. That said, it can be a fantastic technology that works great for many individuals. I have extensively used Skype/Online Services for personal counseling, career counseling (job search techniques, resume writing and interview scripting and rehearsal) and LPC Intern Supervision. I have found that more and more people like the flexibility and are comfortable with services delivered through this technology. Often, a combination of both face-to-face and Skype/Online services are a highly effective strategy.  Skype/Online services may be especially suited for those individuals who find themselves in the following type of life situations:

•   Prefer not to travel, pay for parking, fight Houston, San Antonio or Boerne traffic (Yuk!), receive vulgar hand/finger signals and have profanities thrown at them

•   Desire sessions in the comfort of their home or office

•   Have young children and find it hard to get a sitter

•   Are disabled or have health limitations and find phone or webcam counseling more suitable

•   Find themselves constantly traveling as a result of their job demands

•   Are comfortable using technology

•   Do not have a Licensed Professional Counselor in their community

Note: I offer reduced rates of $20 per session (not counting sessions devoted to my writng your resume, cover letter, interview script and taking the assessments) for those clients that choose the Skype/Online counseling option.

User Rating:  / 0

Informed Consent for Career Counseling Lone Star Counseling Solutions

  1. Career counseling is a collaborative process intended to assist you with addressing current career concerns and refining skills for developing your own career.
  2. Time Parameters: Individual appointments are scheduled for 60-minute segments. Being late for an appointment by 20 minutes or more may require that you reschedule.
  3. Confidentiality: As a Licensed Professional Counselor in the State of Texas, I am bound by the Texas Administrative Code, Chapter 681 and the Health and Safety Code, Chapter 611. In accordance with these rules, information obtained in the counseling session or in written form will not be disclosed to any outside person(s) or agency without your written permission except when such disclosure is necessary to "protect you or someone else from imminent harm" or is otherwise legally required and/or allowed by law (such as abuse of a child, elder, or disabled person or court order). If you are under 18, your parents or legal guardian(s) may have access to your records and may authorize release to other parties.
  4. Electronic Transmission: I cannot ensure the confidentiality of any form of communication through electronic media. You are advised that any email sent to me via a computer in a work-place environment is legally accessible by an employer.
  5. Records: I am required by law to maintain records of each time we meet or talk on the phone. These records include a brief synopsis of the conversation along with any observations or plans for the next meeting.
  6. Consultation: Information about you may be discussed in confidence, without revealing your identity, with other career professionals for the purpose of consultation and providing you the best possible service.
  7. Fees and Payment will be collected at the time of service, except where mutually agreed upon in advance.
  8. Cancellation: If you find it necessary to cancel an appointment, please contact me at 281-703-7400 at least 24 hours in advance. Cancellations with less than 24 hours advance notice will be charged a no-show fee. PLEASE INITIAL HERE THAT YOU UNDERSTAND THIS POLICY .

I have read, understood, agree, and consent to the above conditions of service stated. I have also received the notice of privacy practices on this date.
Client Signature:  
Date: 
 
**If you are under age 18, I must have your parent's permission for you to receive counseling and assessment.
I here by grant permission to       to counsel/assess my child,  
Parent Name: 
Parent Signature: 

Date: 
PAYMENT CONTRACT FOR LONE STAR COUNSELING SOLUTIONS
The following is a statement of the financial policy. It is requested that you read and sign this statement prior to beginning services. Full payment is due at time of service. Payment methods include: Check, Cash, PayPal, Visa/MC/Discover/Amex. A fee will be assessed to your account for all returned checks. Clients using charge cards sign below allowing the provider to automatically submit charges to the charge card after each session and can change payment information at any time.
FEDERAL TRUTH IN LENDING DISCLOSURE STATEMENT FOR PROFESSIONAL SERVICES
Part One: Fees for Professional Services
$110 is charged per in-person (IP) session and $90 per Skype (S) session (each defined as 60 minutes)
$110 (IP) or $90 (S) is charged for missed appointments or cancellations with less than 24 hours notice.
$27.50 (IP) or $22.50 (S) is charged for extended email/phone communication in 15 minute increments.
$95 fee for 2 assessments with detailed analysis.
Note: $20 discounts are offered for Skype sessions (see website for details).
I also take Blue Cross Blue Shield of Texas. Clients are responsible for co-pays and possibly costs associated with their deductible/co-insurance at each session. Please check with your insurance company to determine what your costs will be.
Part Two: All Clients
Payments, testing/assessment fees, and related fees are due at the time of service. Services will be terminated if timely payment is not made as agreed to by this consent.
Part Three: Minors
The adult accompanying a minor (or guardian of the minor) is responsible for payments for the child at the time of service.
I HERE BY CERTIFY that I have read and agree to the above terms and conditions and accept full responsibility for payment of all fees at the time of the visit, unless other arrangements have been made.
Client's Name:   DOB:  
Person responsible for account:     Date: 
NOTICE OF PRIVACY PRACTICES -LONE STAR COUNSELING SOLUTIONS
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 Notice is effective as of November 22, 2014.
I am required by applicable federal and state law to maintain the privacy of your health information and inform you of my privacy practices, legal obligations, and your rights concerning your health information. I must follow the privacy practices that are described in this Notice (which may be amended from time to time).
I am required to abide by the terms of the Notice of Privacy Practices that is most current. I reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that I maintain. The revised Notice will be posted in the waiting room. You may request a copy of the revised Notice at any time.
I will answer your questions about my privacy practices and do ensure that I will comply with applicable laws and regulations. I will also take your complaints and can give you information about how to file a complaint.
I am required to abide by the terms of the Notice of Privacy Practices that is most current. I reserve the right to change the terms of the Notice at any time. Any changes will be effective for all protected health information that I maintain. The revised Notice will be posted in the waiting room. You may request a copy of the revised Notice at any time.
I will answer your questions about my privacy practices and do ensure that I will comply with applicable laws and regulations. I will also take your complaints and can give you information about how to file a complaint.
I. USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION THAT MAY BE MADE TO CARRY OUT HEALTHCARE OPERATIONS.
I may use and disclose limited information from your record without your written authorization, excluding Counseling Notes as described in Section IV, for certain purposes as described below. The examples provided in each category are not meant to be exhaustive, but instead are meant to describe the types of uses and disclosures that are permissible under federal and state law.
Treatment: I may use and disclose limited information in order to provide treatment to you. For example, I may use information to diagnose and provide counseling service to you. In addition, I may disclose information to other health care providers involved in your treatment.
Payment: I may use or disclose limited information from your record to obtain payment for the services you receive. For example, I may submit your diagnosis with a health insurance claim in order to demonstrate to the insurer that the service should be covered.
Health Care Operations: I may use and disclose information (not your name or other identifying information) from your record to allow health care operations including quality improvement activities, intern training programs, reviewing records to see how care can be improved, accreditation, certification, licensing or credentialing activities. For example, I may use information in your record to train another counselor.
II. YOUR INDIVIDUAL RIGHTS
Right to Inspect and Copy. You may request access to the information in your record maintained by me in order to inspect and make a copy of it. All requests for access must be made in writing. Under limited circumstances, I may deny access to your records. I may charge a fee for the costs of copying and sending you any records requested.
Right to Request Restrictions. You may ask to restrict the use and disclosure of certain information in your record that otherwise would be allowed for treatment or payment. You must request any such restriction in writing. I am not required to agree to any such restriction you may request.
Right to Accounting of Disclosures. You have the right to request an accounting of any disclosures made by me after March 29, 2005.
Right to Request Amendment: If you believe information in your record is inaccurate or incomplete, you may request amendment of the information. You must submit sufficient information to support your request for amendment. Your request must be in writing, and it must explain why the information should be amended. I may deny your request under certain circumstances.
Right to Obtain Notice. You have a right to obtain a paper copy of this Notice upon request.
Right to Complain. You have the right to complain to us about our privacy. You have the right to complain to the Secretary of the Department of Health and Human Services about our privacy practices. You will not face retaliation from us for making complaints.
Except as described in this Notice, I may not make any use or disclosure of information from your record unless you give me your written authorization. You may revoke an authorization in writing at any time, but this will not affect any use or disclosure made by us before the revocation. In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer may have the right to contest the policy or a claim under the policy even if you revoke the authorization.
III. USE OR DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION THAT I AM REQUIRED TO MAKE WITHOUT YOUR PERMISSION.
Communications between a counselor and client are privileged and may not be disclosed without your permission, except as required by law. For example, counselors must report suspected abuse/neglect of a child, elder, or disabled person. I may have to breach confidentiality if you appear to post an imminent danger to yourself or others, in order to reduce the likelihood of harm to you or others. Also, I must disclose information to the Department of Health and Human Services, if requested, to prove that I am complying with regulations that safeguard your health information
I may disclose information from your record if ordered to do so by a court, grand jury, or administrative tribunal. Under certain conditions, I may disclose information in response to a subpoena or other legal process, even without a court order.
You have a right to receive confidential communications from me. For example, if you want to receive bills and other information at an alternative address, please notify me. I may contact you to provide information or appointment reminders as a courtesy. Please notify me if I am not to leave a telephone message or use electronic communication. You are responsible for remembering your appointment, whether or not you receive a reminder.
I may contact you with information about treatment alternatives or other health-related benefits or services that may be of interest to you.
IV. USES AND DISCLOSURES REQUIRING YOUR WRITTEN AUTHORIZATION
Counseling Notes: Notes recorded by your counselor documenting the contents of a counseling session with you ("Counseling Notes") will be used only by your clinician and will not otherwise be used or disclosed without your written authorization.
Marketing Communications: I will not use your health information for marketing communications without your written authorization.
Other Uses and Disclosures: Uses and disclosures other than those described in Section I & III above will only be made with your written authorization. For example, you will need to sign an authorization form before I can send information to a school, or to your attorney. You may revoke any such authorization at any time.
Outside Contact and Emergencies
You may leave a message for me on my private, confidential voice mail (281-703-7400) at any time. I check my messages daily, and I will return your call as soon as I can. However, this number is not an emergency phone number.
In the event a situation arises that requires immediate attention, and I am unavailable, please contact your local law enforcement office (911), or go directly to the nearest emergency room. You may also call the crisis line at1-877-466-0660.
Again, please feel free at any time to ask me any questions you may have about the information outlined in this or any of my other forms.
I have understood and received a copy of this agreement.
Signature of Client: 
Date: 
 
 
    

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Message to Parents

Career Counseling for Students

When should your child begin thinking about their career? This is one of the most important decisions your child will make in their lives. So, how do we normally handle this milestone? Well, for most of us parents we wait for the decision to fall into your child’s lap; some sort of heavenly immaculate career reception.

I believe this critical decision needs to be methodically planned through an intense individualized career exploration process; identifying career interests, skills, work values and personality factors. Ideally, this should begin as early as 8th grade and be repeated again in your child’s junior or senior year of high school. Once some well thought out career and occupational areas are identified, your 8th grader can then better select their high school electives. Additionally, they can focus on volunteer work and/or internships and training programs to test out their initial list of career interests. Furthermore, they can talk to people already employed in their areas of interest to get some direct answers to a series of probing questions.

Can you imagine the impact this would have on the career decision making of your child? Rather than wasting high school and college credits and tuition, not to mention the incredible waste of time (this is why so many young people take 5 to 6 years to graduate college), this would be a well thought out decision, evolving early and throughout your child’s high school years.

At Lone Star Counseling Solutions, we are experts at working with your child to systematically identify career options, and then draw up a plan to incorporate this information into their high school and college educational plan. Are you ready? Let’s get started!

College Preparation and Planning

As a lifelong counselor and educator, who has worked with countless high school students, I have the expertise and experience to take your child through the transitional journey from high school to college to career.

I meet and discuss with you and your child background information, coursework, grades, test scores, strengths and potential blind spots. In addition, we conduct an extensive identification of college preferences concerning major, career goals, college offerings, enrollment, special needs, geographical location, costs and financial aid options, social aspects, leadership opportunities, student characteristics, extracurricular activities and other college factors.

Building on your child’s extensive career counseling exploration and discovery program, I then move toward my comprehensive college planning system that includes the following:

  • College Matching and Selection: Identify college options that fit their individual needs, interests and abilities, including special areas (i.e. dance, theatre, business, visual and performance arts). Develop preliminary list of colleges tailored to the student’s needs and the family’s financial situation. List is updated as the student evaluates each school.
  • Assistance with applications to colleges
  • Deadline Tracking and Application Critique
  • I work with your child through the application process so they are less intimidating. I keep kids on track throughout the busy application season, since it is critically important that we do not miss a deadline. I also review all applications before they go out the door (actually the internet), because I almost always find mistakes. In this way, I make certain that your child’s applications are well crafted and polished while still reflecting the student’s unique voice.
  • College essay coaching and resume development
  • The essay is one of the most important elements in the student’s application process. This is not an easy task and requires expertise in order to write a unique essays describing who they are and where they’re going. I provide detailed coaching and guidance based on the student’s unique characteristics and style. While I do not write the essay for the student, I offer thorough coaching throughout the difficult and often overwhelming process. Many students have no idea what to write about or how to go about it. I use my college admissions experience to focus their efforts and attention and take the necessary action steps to write a high quality essay. I also help students build a professional resume of achievement to include with their application.
  • Financial Strategy and Affordability Counseling
  • The cost of a 4 year degree at an in-state public college for the 2013–2014 academic year averaged almost $23,000 a year or $92,000 for four years. The cost of a private education is approximately $45,000 per year and $180,000 for four years. It is one of the most expensive investments you will ever make, yet most people spend more time researching what type of car to buy than the college to which they send their child. For this reason, it is imperative that we discuss and analyze affordability based on the income and assets of your family early in the process. I will suggest some ways to maximize merit and need based aid, while minimizing the overall cost to your family. Additionally, I will assist your child in identifying possible scholarships they might qualify for. By integrating the college search process with financial strategy, your family will be better equipped to find schools you can actually afford.
  • Advising for standardized testing/admissions testing/test preparation and tutoring (SAT, ACT, Advance Placement, and SAT Subject Exams)
  • Supplying names of colleges that do not require the SAT or ACT, but emphasize other special qualities (talents, skills, unique experiences, etc.).
  • Identifying colleges and universities that offer special needs support.
  • High School Transcript Analysis & Course Selection
  • College admissions officers understand the vast differences that exist among our nation’s 30,000 high schools, while many parents do not. This is why a thorough review of a student’s high school transcript is critical. After an assessment of a student’s grades, interests, and academic skills, I recommend appropriate courses to maximize their chance for success in high school. Every student is unique, but in general, the most rigorous classes are favored by most colleges.
  • Career/Personal Interest Inventory and Counseling (Optional)
  • As I mentioned in my “Message to Parents” above in the “Career Counseling for Students” section, I believe all good decisions are based on thorough exploration, self-discovery and solid information. Therefore, I highly recommend that each student complete the Strong Interest Inventory (this is a web-delivered personality/career interest inventory). Each student will receive a personalized report detailing their interests and personality factors resulting in a match with occupations, careers and college majors that fit their personality. This will serve as an important factor in the process of creating a customized list of potential colleges for the student to pursue.
  • How to arrange your visit to interested colleges
  • Campus Visit Guidance and Interview Preparation
  • There are good and bad ways to visit a college campus. I provide guidance on how to make the most of campus visits.
  • Study Skills Development (Optional)
  • After entry into the college of their choice, it makes sense to develop and refine successful study skills strategies. Using a variety of tools and devices I can assist your child some tried and true study skills and time management tactics to improve their chances for success.

Using my systematic approach, expertise and knowledge we move together toward making a final and fulfilling college decision with your child. Ultimately, it should be all about focusing on “fit and match”. That’s what I do at Lone Star College and Career Planning Solutions.

Cost for the basic package is $300 for the first session and $100 per hour for all work performed afterwards, including optional services listed above.

All services are available via Skype/Online Counseling.

Message to Parents - 4.7 out of 5 based on 12 votes
User Rating:  / 6

Resume and Cover Letter

 

Your resume only receives a quick glance, at best, so we will will work to make it powerful and reflective of your skills, talents and abilities.  We will discuss, critique and fine tune your resume and cover letter so that the content and format reflect your value to the companies, corporations, organizations or agencies that you are applying to. 

With the job market being so competitive and interviewers receiving so many applications, we need to seperate you from the "pack" (it truly is like a "dog eat dog" market).  As Vice President at a large college, I have interviewed, read resumes and poured over cover letters from hundreds of applicants, ranging from senior managers to entry level staff.  I have real life experience and know what it takes to help you stand out as an applicant.  We will work together to create hard hitting metric based application materials that will get you interviews.  My work at the college, helping them create a performance management system that is widely used in industry and educational systems, also provides me with practical experience on how to impress a prospective employer.  We will reach the "WOW" factor.

Charge is $110 per session

Resume and Cover Letter - 4.5 out of 5 based on 6 votes
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Terms & Condition

User Rating:  / 5

Interviewing Skills

 

This is truly the "make it or break it" part of the job hiring process.  We will create a commanding script for the most commonly asked questions that will "knock the socks" (they're probably not wearing flip-flops) off of your interviewer.  This is our goal!

We will conduct mock interviews with critique in order to prepare you to be confident, highly effective and focused during your interview process.  It is a horrible situation to get the initial screening process, get invited to interview and not perform at your best. I promise to do my best to team up with you to get you your dream job.

Charge is $110 per session

Interviewing Skills - 4.6 out of 5 based on 5 votes
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Privacy Policy

User Rating:  / 12

BROOK MATLIN ZEMEL

 

1 Doeskin Drive

Apt. 1601

Boerne, Texas 78006

Mobile: (281) 703-7400

This email address is being protected from spambots. You need JavaScript enabled to view it.

 

EDUCATION:

 

Ph.D Counseling Psychology/Testing and Measurements; Washington State University; 1985. Title of Dissertation: The Effects of a Computer-Based Career Guidance System (SIGI) on the Career Maturity of College Students. (Chairperson: Dennis A. Warner, Chairperson: Department of Counseling Psychology.)
  
M.S. Counseling and Student Personnel Administration; Indiana University; 1976.
  
B.A. Speech Communication and Sociology; University of Denver; 1973.

 

 

PROFESSIONAL LICENSES:

 

Licensed Professional Counselor- Supervisor (LPC-S) State of Texas (No. 08760)

 

HIGHER EDUCATION ADMINISTRATION:

 

Vice President of Student Development (retired),San Jacinto College District, Pasadena Texas;2006-August 31, 2012.San Jacinto College is an “Achieving The Dream Leader College”.Managed the operation of the Student Development Division across three campuses. Supervised over eighty full time employees in order to deliver high quality services to over 30,000 credit students who attend and all other individuals utilizing these services. These services included: counseling, educational planning/advising, student success/retention, First Year Experience program (FYE), International Student Program, disability services, recruiting and outreach and student discipline and judicial board.The First Year Experience Program/Student Success Centersare responsible for the FYE Calling Program that trains student leaders who provide a peer-to-peer outreach to all first time in college students. Referrals are then made to appropriate support services at the college. Led and coordinated an all college “faculty advisingprogram”with the Deputy Chancellor, Deans of Student Development, and individuals within the instructional division. The faculty advising program was introduced and incorporated into all student success courses at the college. In addition, designed a program that provided critical support services for all student success courses. This included a series of points of contact including the following in-class interactive presentations: creation of a college email account, support services available to all students, career testing and planning, development of individualized short and long term educational plans, and registration for the following semester.Developed and implemented a college-wide “Communication Plan” which   established a strategic enrollment management system and process for recruiting and enrolling students at the college. This plan was created with up to thirty-four points of contact and designed to significantly increase yield and enrollment at the college. Included as part of the FYE program, is a mandatory new student orientation, a bi-weekly student success newsletter, and educational planning and career development workshops that wereincorporated into the college’s required student success course. One of three team members who redesigned the entire student services division in order to maximize efficiency, streamline processes, and improve the quality of servicesprovided without increasing the overall student services budget. This involved the creation of a “one-stop-shop” system, whereby most students can receive all of their services at an enrollment and information bar. Participated in the planning and design of two new “one-stop-shop” student services buildings at the college. Each of these facilities house all of the student services for these campuses, and provides an easy and friendly pathway for new students to matriculate into the college and current and former students to receive the critical assistance they require. Another major responsibility is the “Shared Counselor/Educational Planner” program which places a SJC counselor in 13 feeder high schools providing services that promote success and attendance at college. Developed a highly creative and dynamic leadership team that planned, implemented and measured the effectiveness of all programs and initiatives, as well as staff accountability within the student development division. Assisted with the implementation of a performance management system at the college that uses a “cascading” system of strategic planning and goal setting and ties in college-wide, divisional, and departmental objectives and metrics.

 

Vice President of Student Services, San Jacinto College South, Houston, Texas; 2001 to 2006; interim basis 1999-2000.Served as thesenior officer responsible for executive oversight and development of services and programs including: counseling, advising, international students, special populations, child care center, testing, financial aid, student life, career and employment services, food services, intercollegiate athletics, commencement, recreational sports, marketing and recruiting. Provided leadership, visioning, strategic planning, and budgeting processes to insure continuous development of student and campus support services consistent with the institutional mission and goals. Conducted a number of process and function reviews in order to improve the quality of services provided at the college. Assisted with the creation of a college-wide “Call Center” which fields nearly 500,000 calls per year. CallCenter specialists are highly trained in all student services areas and can resolve most student concerns quickly and without transferring the student to another campus office.

 

 

Associate Dean of Student Development;Director of Counseling, Testing and Placement, San Jacinto College South, Houston, Texas; 1989-2001. This position was upgraded from Director to Associate Dean in 1999. Managed all functions within a comprehensive student services unit: counseling (academic advising/ personal and career counseling), testing, placement, international student program, and recruiting. Supervised eleven full-time and six part-time staff which entailed ongoing professional training and development. Administrated a $465,000.00 budget. Coordinated special projects including: workshops, testing, statistical reports, peer assistance program, community outreach, computerized career guidance systems, marketing/publicity, recruitment, college night, job fair, job resource bank, and articulation agreements between the San Jacinto College District and all major public and private universities in the state. Responsible for the coordination of Start Trek, a program designed to motivate eighth grade students to complete and excel in their educational pursuits. Developed and implemented an orientation program designed to afford students an opportunity to complete all necessary steps to enroll at the college (testing, interest sessions, and advising). Served as the disciplinary administrator for the campus. Developed a federally funded grant which established the development of a career and personal development resource room within the center.

 

 

Coordinator, Leadership Development Program, San Jacinto College District, Houston, Texas; 1997-Present. Appointed by the Chancellor to develop the first comprehensive leadership program for administrators and managers within the San Jacinto College District. This program was designed to provide leadership development through a professional speaker series, a training component which allows individuals an opportunity to attend national, state, and local conferences and institutes, and an in-depth campus-based seminar track which incorporates specialized classes.

 

Chairperson, Presidential Search Committee, San Jacinto College South, Houston, Texas, 1997. Served as the chairperson of the Search Committee for the President of San Jacinto College South. The committee employed the guidelines set forth by the Association of Community College Trustees (ACCT).

 

Directorate, Commission XI, American College Personnel Association (ACPA), Washington, D. C. 1997-2000. Member of the commission which promotes the improvement of student development programs and enhances the professional development of student development personnel in two-year colleges.  

 

Member, Ad Hoc Examination Committee, Texas State Board of Examiners of Professional Counselors; Austin, Texas; 1989-1999. Reviewed, revised, and developed the data base of the examination items for professional licensure in the state of Texas.

 

Co-Chair, Committee on Career Development for Adults' (Post-Secondary). National Career Development Association; 1988-1996. Established goals, organized special projects, supervised production of various programs, and increased membership from 10 to 65 members.

 

Chair, Wellness Committee, Galveston College, Galveston, Texas; 1985-1987. Implemented a comprehensive wellness program based on the model developed by the Institute for Holistic Lifestyling. Programming of athletic activities, seminars, and forums including: smoking cessation, stress management, assertiveness training, and various other participatory events.

 

Registrar/Veterans' Affairs Officer, Lexington Community College, Lexington, Kentucky; 1977-1979. Responsibilities included registration, records, and transcripts, administering diplomas, evaluation and advising students with academic problems. Duties included budget formation, veterans' registration, verifying employment, and supervising four full-time and three part-time employees.

 

COUNSELING EXPERIENCE:

 

Owner/Counselor,Lone Star Counseling Solutions, Boerne and Houston, Texas; 2013- present. Owner and counselor for a comprehensive counseling services private practice. Provide career counseling, assessment, goal setting, interviewing skills,job search and resume/cover letter writing. Work with individuals who are experiencing grief and loss in their lives with a unique level of insight, empathy and understanding that is provided only through the experiential part of life.When working in the areas of stress management, self-esteem, relationships and personal growth issues, mainly employ cognitive behavioral and solution-focused strategies to help clients work through challenges, learn new skills and achieve their goals.

 

Allied Health Professional Associate, Baywood Hospital, Webster, Texas; 1990-1992.
Provided therapy to individuals who are receiving in-patient mental health services. Counseling consists of holistic work in the areas of stress management, cognitive restructuring, coping, and problem solving skills as they relate to career and life planning issues.

 

Counselor, CounselingServices, San Jacinto College Central, Pasadena, Texas; 1988-1989. Assisted students in regard to their choice of career, personal-social effectiveness, emotional well-being, and educational goals. Administered and interpreted computerized vocational, personality and placement testing. Conducted workshops/groups on topics pertinent to students needs: stress management, test anxiety, career exploration, study skills, time management, resume writing, and interviewing techniques. Editor for the Counselors' Dialogue, a published newsletter which links the college with area high schools and intermediate schools.

 

Psychotherapist, Private Practice, 5 Oak Tree, Friendswood, Texas; 1988-1993. Provided therapy for individuals, couples, and groups concerning: self-esteem, stress management assertiveness, depression, and interpersonal relations.

 

 

Counselor, Counseling Services, Galveston College, Galveston, Texas; 1984-1988. Provided comprehensive counseling services to students including personal counseling, career counseling, and academic advising. Administered and evaluated placement, vocational and psychological tests. Conducted crisis intervention, research, individual and group counseling. Directed the "Para-Pro Program an outreach service utilized by the University and community.

 

 

Counselor (Assistantship), Career Services, Washington State University, Pullman Washington; 1983-1984. Counseled students using a holistic approach, to facilitate their career and life development. Assisted in exploring values, self-concept, interests, abilities and decision-making skills. Administered and assessed vocational tests in individual and group settings.

 

 

Psychological Counselor (Practicum), Psychological Services, Washington State University, Pullman, Washington; 1983-1984. Leader of a psychotherapy group which provided members with the unique opportunity of exploring communication, self-esteem and interpersonal and family conflict.

 

Counselor (Practicum), Psychological Services, Washington State University, Pullman, Washington; 1982-1983. Provided individual psychotherapy dealing with eating disorders, interpersonal communications, substance abuse, stress management, assertion, self-concept, and depression.

 

Counselor, Edison Community College, Naples, Florida; 1979-1981. Counseled students concerning educational, developmental, vocational, social, personal, and family concerns. Advised students in accordance with their educational plans. Administered, scored, and processed the educational, psychological, and vocational tests available to college and high school students.

 

 

TEACHING EXPERIENCE:

 

 

Faculty, University of Houston-Clear Lake, Houston, Texas; 1991-1999. Instructor for Life/Work Planning (PSYC 5335). Incorporate the theory and applied aspects of work and adult developmental psychology. Focuses on self-assessment in order to facilitate understanding of the relationship among personality, values, interests, skills and abilities, motivational patterns, decision-making styles, and self-concept. In addition, modules include resume writing, job search techniques, and skills for interviewing.

 

 

Faculty, University of Houston-Clear Lake, Houston, Texas; 1990-1999. Instructor for the Graduate School Counseling Internship (COUN 6739). Direct supervision of graduate students who are providing psychotherapeutic services; individual, small group and family. Consultation and coordination of services provided with site supervision.

 

Faculty, University of Houston-Clear Lake, Houston, Texas; 1987-1990. Instructor for the Graduate School Counseling Practicum (COUN 5739). Provides professional supervision for graduate students in the application of therapeutic skills, techniques, and concepts in order to enhance their competencies in the helping relationship.

 

Instructor, University of Houston-Clear Lake, Houston, Texas; 1985-1992. Instructor for workshops in career exploration. Incorporates an integrative approach in order to recognize aspects of one's life: needs, interpersonal relations, personal value systems, interests, skills and abilities, family systems, impact of self-concept, and decision-making skills.

 

Instructor, San Jacinto College Central, Pasadena, Texas; 1988-1990. Instructor for an orientation course which covered a variety of topics; self-concept, study skills, time management, career, and decision making skills.

 

Faculty, University of Houston-Clear Lake, Houston, Texas; 1988. Instructor for the Graduate School Counseling Psychology Seminar (PSYC 5741). Provided didactic and microskills training. Afforded students an opportunity to integrate and apply the principles of counseling theory, skills, and techniques to be utilized in the resolution of client problems and concerns.

 

Faculty, Galveston College, Galveston, Texas; 1984-1988. Instructed courses in human potential (i.e. career development, study skills, interviewing, resume writing, job search, time management, assertiveness, training, stress management, test anxiety and systematic desensitization).

 

Instructor, Washington State University, Pullman, Washington; 1983-1984. Instructed courses in career development which focused on teaching models for decision-making; helping students to assess their interests, skills, and abilities; and the process and implications of selecting a major and career.

 

Faculty, Edison Community College, Naples, Florida; 1979-1981. Taught courses in psychology, human development, and personal social adjustment. Topics centered around personality functioning, psychological theories and concepts, human behavior and interpersonal relationships.

 

Instructor, Edison Community College, Naples, Florida; 1979-1981. Conducted seminars designed to help students experiencing academic difficulties. Included development of behavioral objectives to help increase student motivation, self-worth, and the establishment of life goals.

 

 

PUBLICATIONS:

 

Zemel, B. Stop “Aflfluenza” Cold? - Go “Old School” on Your Kids, STA Wealth Management, April 14, 2014. 
 http://streettalklive.com/index.php/component/flexicontent/2-the-daily-x-change/2169-stop-affluenza-cold-go-old-school-on-your-kids.html?Itemid=164

 

Zemel, B. How Soon Should You Talk to Your Kids about Their Career?, STA Wealth Management, April 3, 2014. http://streettalklive.com/index.php/component/flexicontent/2-the-daily-x-change/2142-how-soon-should-you-talk-to-your-kids-about-their-career.html?Itemid=164

 

Zemel, B. Getting Started with Your Child’s Financial Aid, STA Wealth Management, March 21, 2014.  http://streettalklive.com/index.php/component/flexicontent/2-the-daily-x-change/2136-getting-started-with-your-child-s-financial-aid.html?Itemid=164

 

Hellyer, B., Raffetto, B., Zemel, B. An enrollment bar- A solution for your campus? Innovation Abstracts, 30, 8, 2008.

 

Zemel, B. and Henson, D. (1993). A review of the Campbell Interest and Skills Survey (CISS).

Career Developments for Adults Infoline

, (1-4).

 

Zemel, B. and Hanna, M. (1991). A comparison of the effects of three interventions on the career maturity of college students. Texas Association for Counseling and DevelopmentJournal, 19, 63-72.

 

Beales, J., & Zemel, B. (1990). The effects of high school drama on social maturity. The School Counselor, 38, 46-51.

 

Venditti, P., & Zemel, B. (1989, Spring/Summer). Community   college counseling: Justifying it and improving it. MarylandAssociation for Counseling and Development Journal, 18-25.

 

Venditti, P., & Zemel, B. (1988). The selection process: An overlooked tool for getting high performance from child care employees. Texas Child Care Quarterly, 12, 25-28.

 

Zemel, B., &Venditti, P. (1987). Implementing a college wellness program on a shoestring. Innovation Abstracts, 9, 16.

 

 

PROFESSIONAL PRESENTATIONS:

 

 

The Center for Community College Student Engagement, in cooperation with the Community College Leadership Program's initiative in conjunction with Achieving the Dream, ESSI Institute Annual Conference in Austin, TX; April 12, 2010: The First Year Experience Program Calling Program.

 

League for Innovation in the Community College, Conference on Information Technology in Charlotte, NC; October 24, 2006: Building Customer Service Within the College Environment.

 

Junior College Student Personnel Association of Texas (JCSPAT); Annual Conference in Austin, Texas; November, 2004: Student Services Ideas that Work: You Show me Yours and I’ll Show You Mine.

 

San Jacinto College Leadership Team; Houston, Texas: June 1998: The Leadership Engine: How Winning Organization Create Leaders at Every Level.

 

Junior College Student Personnel Association of Texas (JCSPAT); Annual Conference in Odessa, Texas; November, 1993: Genograms: A Useful Tool in Career Counseling.

 

Texas Counseling Association; Annual Convention in San Antonio, Texas;     November, 1992: Genograms: A Useful Tool in Career Counseling.

 

Bay Area Business Association; Houston, Texas: February 1992: Time Management: Skills for Managers.

 

Clear Creek Independent School District; Houston, Texas: January 1992: Parental Role in Facilitating Career Decision Making Strategies in High School Students.

 

American Counseling Association; Annual Convention in Reno, Nevada; April, 1991: Career Counseling: Individual and Group Techniques Within a Developmental/Systems Framework.

 

Texas Association of Vocational Nurse Educators; Annual Convention in Austin, Texas; April 1991: Cognitive Behavioral Theory: Increasing Student Performance and Retention.

 

National Career Development Association; American Counseling Association for Counseling and Development; Annual Convention; Boston, MA; March 1989: Career Counseling: Individual and Group Techniques Within a Systems Framework.

 

Clear Lake Symposium; Houston, Texas; February 1988. Stress Management Techniques and Their Applications.

 

Texas Association of Child Care Administrators; Annual Convention; Galveston, Texas; July 1986: Motivation: Strategies for Selection, Training, and Development.

 

Junior College Student Personnel Association of Texas; Excellence: Its Time Has Come Again; Galveston, Texas; November 1985: How to Get People Involved in Wellness Programs Which Advance Institutional Excellence.

 

Washington State Substance Abuse Coalition; Building a Vision conference; Ellensburg, Washington; October 1983: The College Scene; What Can be Done for Substance Abuse Prevention at the College Level.

 

Washington State Leadership Conference; Pullman, Washington; February 1983: Leadership Styles for Effective Program Development.

 

Washington State University Symposium; Psychotherapy in Group Settings, Pullman, Washington; April 1983: Techniques and Practical Applications of Group Psychodrama.

 

HONORS

 

Voted “Boss of the Year” by the San Jacinto College District’s Association of Educational Office Personnel, 1995.
Recognized as outstanding graduate student in Counseling Psychology by Kappa Delta Pi, Washington State University, 1984.

 

PROFESSIONAL ORGANIZATIONS (past and present)

 

NACADA(National Academic Advising Association)

ACA (American Counseling Association)

NCDA(National Career Development Association)

TCA(Texas Counseling Association)

ACPA(American College Personal Association)


 INTERESTS

Avid golfer, hiker, international travel, sailing, snow skiing, snowshoeing, pottery on the wheel, writing and performing music, and eclectic reading


BROOK M. ZEMEL

 

curriculum - 4.6 out of 5 based on 12 votes
User Rating:  / 7

Job Search


Traditional and creative job search strategies will be discussed, along with associated resources.

Charge is $110 per session

Note: I offer reduced rates of $20 per session (not counting sessions devoted to my writng your resume, cover letter, interview script and taking the assessments) for those clients that choose the Skype/Online counseling option (for more information, see the section on Skype/Online Counseling).

job_search - 4.9 out of 5 based on 7 votes
User Rating:  / 17

Counseling Services

 

I believe we all get stuck and establish certain patterns of behavior that are making our lives more difficult than necessary.  

Additionally, we all find ourselves in situations and life events that test our strength and ability to cope with life. Stress, grief and loss, relationships, self-esteem, our career and job, depression, and just a general lack of direction and purpose are all issues that affect us. On a personal note, I feel well qualified to work with individuals who are experiencing grief and loss in their lives.  My wife and I traveled a terrible journey of our own, having lost our beloved daughter to cancer at age 14. I use a solution based approach, built on cognitive behavioral principles, and work with you to identify your strengths, resources and new ways to approach and improve your life.  Along with solid counseling strategies, I am a strong proponent of using humor at appropriate times to help you tackle your life challenges.

 My Ph.D. in counseling, along with nearly 40 years of training, college teaching and serving as the Vice President of Student Development at a large college uniquely qualifies me to effectively work within the realms of career and personal counseling. I employ a broad based set of skills and strategies that lead to successful solutions and improvements in your life.Call me and let's get started now working together toward the happiness you seek in your life.

Cost for counseling:  $110 per hour (60 minutes) in-person (IP) and $90.00 per hour (60 minutes) Skype (S).  
If you request additional time my charge is $110 per 60 minute session or quarter increments of $27.50 (IP) and $22.50 (S).

Note: For the hourly counseling,  I offer reduced rates of $20 per session (not counting sessions devoted to taking the assessments) for those clients that choose the Skype/Online counseling option (for more information, see the section on Skype/Online Counseling).

 

Counseling Services - 5.0 out of 5 based on 17 votes
User Rating:  / 9

Career Counseling

Let’s face it, if you are going to work 93,000 hours of your life, you want to be happy with the duties, responsibilities, salary, advancement opportunities, job security and all other facets of the job.  If not, your days will be miserable and will affect every aspect of your life (then you’ll find yourself unhappy and back in my office).  If you are dissatisfied in your career, it is highly likely that you are experiencing some level of anxiety, stress, sadness, depression, anger or frustration.  If this is the way you are feeling then t's quite common to take out your unhappiness on your family, co-workers and friends.  Additionally, the anxiety of change and indecision often accompany these feelings.  My education, experience and professional licensure as a counselor (LPC-S) allows me to work holistically with you to improve your life, find meaning and purpose, fulfillment and happiness (what's not to like about that?). Let’s spend some focused and deliberate time and effort on ensuring that you are working at a meaningful and satisfying career.  The journey (I promise, it’s not painful and shouldn’t involve lugging luggage around) and effort will be worth it. I absolutely believe that good decisions are based on good information.  My career process involves a thorough and comprehensive exploration of yourself and the world of work.  Through in-person or Skype/On-Line counseling we will work together to develop your goals, objectives, and action plan to get you to where you want to be.  Part of the process might involve the use of assessments that will provide us with critical and insightful information.  Although I have used many different assessment instruments, I like to utilize the following:

  • Strong Interest Inventory (SII)
  • Do What You Are (DWYA)- Personality Self Discovery Assessment
  • Learning Styles Inventory
  • Myers Briggs
  • Strengths Finder

I will customize which assessments are used based on your individual characteristics and needs.  The cost for assessments and a detailed analysis is $95.

Cost for counseling:  $110 per hour (60 minutes) in-person (IP) and $90.00 per hour (60 minutes) Skype (S). 
Note:  If you request additional time my charge is $110 per 60 minute session or quarter increments of $27.50 (IP) and $22.50 (S).

 My counseling services features sessions that provide in-take, assessments, action plans, follow-through, support, feedback, coaching and practice.

  • Note: For the hourly counseling,  I offer reduced rates of $20 per session (not counting sessions devoted to taking the assessments) for those clients that choose the Skype/Online counseling option (for more information, see the section on Skype/Online Counseling).

 

Career_Counseling - 4.7 out of 5 based on 9 votes
User Rating:  / 5

Career Coach

While a Career Counselor can assist you in getting the job you want, a Career Coach provides clients with professional support to successfully navigate career and personal barriers that may be interfering with your maintenance and advancement within the organization. My coaching style educates clients on the strategies, tools and resources available to become more successful in their work life. Together, we will identify possible career barriers to your career movement and success and develop strategies to successfully resolve these issues.

My career coaching assesses the issues affecting your current situation and I offer feedback to help clarify your career goals, objectives, interpersonal and communication style and behaviors. As a professional counselor I can serve as an objective observer, listener and communicator and will work with you to develop a career roadmap to support positive change.

Career Coaching - 5.0 out of 5 based on 5 votes