Request for Free Consultation
Limits to Confidentiality

You need to be aware that the law requires that I report certain
situations. Therefore, there are limits to confidentiality.

Any instances of sexual abuse, or neglect of minors or of the elderly, any
physical abuse of minors or the elderly, or any situation in which you
might cause harm to yourself or others requires that I report such to
authorities.  Also, I am required to report a crime.

Before you share any personal information with me, you should be aware
that even Christian ministers are covered by these laws and are required
to make disclosure.
To Request Your Free Consultation
Please fill out the form below.
Privacy Statement:

We do not share your information with anyone,
except when required by law.
Our request for the personal information below is in order to
carry out our ministry in keeping with legal and ethical standards.
Type "yes" in the box if you
understand that the information
provided above will not be shared
except as required by law.
Type "yes" in the box if you
understand that their are legal limits to
confidentiality and that I am required
by law to report to the authorities any
awareness I have of sexual abuse,
neglect of a minor or of the elderly, of
crimes, and of any danger you pose to
yourself or others.
By typing "yes" in the adjacent box, I
certify that I am an adult, 18 years of
age or older.
If not 18 years of Age, click here.
If we were doing this work commercially,
we would ask for a donation of $60.00 per session.

However, because this is a Christian ministry,
we want to make it available at a cost that fits your budget.

If you decide to continue with sessions after the initial free consultation,
please choose a rate for each session.

Around the first of each month,
we will send you a statement to your above address
itemizing the time I have spent on your concerns.

We ask payments be sent to our post office box rather than our street address.

Send a check or money order to
Becoming
PO. Box 364
Crockett, TX 75835

Remember, the first consultation is free.
Deciding on a rate if for future sessions,
if you choose to continue.

A limited number of scholarships are available due to some caring people
who help underwrite the cost of the ministry.
Choose Rate per session
for future sessions
after the free consultation
Some Firewall Settings Interfere with the form
and send cause a "page not available"
message to appear even when your
information has been sent.

If that occurs, please email me at
donmize@yahoo.com
to confirm your information has been received

Sorry for any inconvenience.
April 26, 2006