“All communications between yourself and me, however created or stored in the context of our professional relationship, are held in the strictest confidence. I will not disclose your identity, or any information about you, to anyone except with your express written permission and my agreement that this is in your best interest.
“The only other exceptions are (1) when I am required by law to report suspicion of abuse, neglect, or exploitation of minors, the elderly, or disabled persons, or any sexual exploitation by a mental health services provider; (2) upon receipt of a valid court order, and (3) if I determine that there is a probability of imminent physical injury by you to yourself or others, or there is a probability of immediate mental or emotional injury to yourself. Although such a circumstance rarely occurs, if it does, I will contact your physician.
“While in my care, your needs come first and foremost, at all times and without exception.”