(1) A licensee shall furnish a professional disclosure statement to a prospective client before engaging in counseling services.
  (2) A professional disclosure statement required under this section shall contain all of the following:
  (a) The licensee’s name, business address, and telephone number.
  (b) A description of the licensee’s practice.
  (c) A description of the education and experience of the licensee.
  (d) The licensee’s counseling fee schedule.
  (e) The name, address, and telephone number of the department.
  (3) The disclosure statement shall accompany the original application for licensure. Any changes in the disclosure statement shall be filed with the department within 30 days after the changes are made.