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Washington County Conciliation Services asks that clients provide their informed consent prior to beginning the New Ways for Families program. Please read the following information carefully, review it with your conciliation counselor if necessary, and provide your signature below to indicate your wish to participate.

Washington County residents with children, who are seeking to resolve issues about their relationship, or to decrease the degree and frequency of the conflict between them, may benefit from the New Ways program through Conciliation Services. This service consists of four group information sessions and four private counseling sessions for you and your co parent. All sessions are ninety minutes in duration. Group sessions shall take place at the same day and time for four consecutive weeks. Private Sessions may be scheduled at your convenience but during normal hours of operation at Conciliation Services. All eligible clients will be served without regard to race, color, and national origin, age, set sexual orientation or disability. All services are included with your registration fee.

The group sessions are designed to provide information to help you solve problems and cope more effectively with difficult decisions and/or transitions in your relationship with your co parent partner. The private sessions provide you and your co parent an opportunity to practice and apply skills to issues that are most relevant to you. To increase the effectiveness and the program you will be expected to take part in activities that support positive change during sessions and between sessions. In addition, you will be expected to attend all scheduled meetings, letting your counselor know ahead of time if you cannot come. Your counselor works collaboratively with a team of qualified professionals, and may consult with other team members about you case in order to make sure you and your co parent get best possible service. If you have been court-ordered Conciliation services shall inform the court of your attendance and level of participation.

You have the right to discontinue attendance at any time. If you have been court-ordered to participate, your counselor will inform the court that you are no longer attending. However, it will be your responsibility to arrange for alternative services to comply with the court order. Registration fees are not refundable.

All information about you and your family will be treated as strictly confidential in keeping with the laws of the State of Oregon, and HIPPAA Privacy Practices. However, there is specific exception of confidentiality which includes:

• Child or Elder Abuse
• Harm to Self or Others
• Subpoena or Court Order
• Your Written Consent
• Drug use and/or manufacturing in the home

By signing this form, you are saying that you have been informed of these confidentiality policies and exceptions to confidentiality.

I have read this consent form and have been able to ask questions. I fully understand its contents and agree to its terms. I agree to participate in both group and private sessions of the New Ways for Families program.

Washington County Conciliation Services asks that clients provide their informed consent prior to receiving counseling services with us. Please read the following information carefully, review it with your conciliation counselor if necessary, and provide your signature below to indicate your wish to begin conciliation counseling services with our agency.

Washington County residents with children who are seeking to resolve issues about their relationship, to discuss issues of separation or divorce adjustment, or to discuss co-parenting concerns can access counseling through Conciliation Services.

There is no fee for your first four counseling sessions. This service is offered to the couples, is intended to be short term in nature, and is not intended to provide mental health treatment for concerns beyond the scope of the separation or conciliation matter. In the event that you or your counselor identifies additional mental health issues that need to be addressed, your counselor will make appropriate referrals to available services within the Washington County area to address your concern. All eligible clients will be served without regard to race, color, national origin, religion, age, sex, sexual orientation or disability.

The counseling services we offer are designed to help you solve problems and cope more effectively with difficult decisions and/or transitions in your relationship with your co parent. To help make counseling work you will be expected to take part in activities that support positive change during sessions and between sessions, and you’ll be expected to attend all scheduled meetings, letting your counselor know ahead of time if you cannot come. If you need to cancel or reschedule a mediation appointment, it is your responsibility to notify the other participant(s) and contact Conciliation Services; failure to contact Conciliation Services at least 24 hours prior to your scheduled appointment may result in the loss of one of your no fee sessions.

You have the right to stop counseling at any time. If counseling has been court-ordered, your counselor will inform the Court that you are no longer attending counseling. However, it will be your responsibility to arrange for alternative services to comply with the court order.

Your counselor works collaboratively with a team of qualified professionals, and may consult with other team members about your case in order to make sure that you and your counseling partner get the best possible service. All information about you and your family will be treated as strictly confidential in keeping with the laws of the State of Oregon, and HIPAA Privacy Practices. However, there are specific exceptions to confidentiality which include:

• Child or Elder Abuse
• Harm to Self or Others
• Subpoena or Court Order

Your Counselor will further explain these exceptions to confidentiality during your first session. By signing this form, you are saying that you have been informed of these confidentiality policies and exceptions to confidentiality.

I have read this consent form and have been able to ask questions. I fully understand its contents and agree to its terms. I give my permission for conciliation counseling to commence.

Court Connected Mediation Package - $200 per person

• Includes: Mediation Orientation and Parent Education* in one group session, plus 1 mediation session (available until the final court judgement).
• Each Additional Mediation session $125 per person.
• Fee waived if court fees are waived, must submit proof of court approval.

* Parent Education is replacing the Kids' Turn Program offered through Youth Contact.

Voluntary Mediation - $125 per person per session 

• Session scheduled for 2 hours.

New Ways for Families - $250 per person

• Includes: 4 group skill building sessions plus 4 co-parent counseling sessions. 
• Fee reduced to $150 if court fees are waived, must submit proof of court approval.

Co-Parent Counseling - $93.75 per person per session 

• Session scheduled for 90 minutes.
• Fee does not apply to the 4 sessions included with New Ways for Families

Expert Witness Testimony - $100 nonrefundable fee

• Must accompany a properly served subpoena.
• $25 per 15-minute segments testifying or waiting to testify.
• Does not apply to mediations, as mediators are not available to testify.

No Shows

• Missed appointments with less than 24-hour notice may be counted as a session.

The County's Notice of Privacy Practices outlines how the County may receive, use or share health information about you.

Read and download Notice of Privacy Practices