Consent

Parental Consent for Treatment of Minors — This form can be used when working with children and teens in individual treatment. It is recommended that clinicians meet with the parents/guardians, and then with the children or teens, as appropriate to their developmental level. This will assist discussions with the child regarding confidentiality, information sharing, and records access. (0720)

Telehealth Group Counseling Agreement — This form can be given to clients who are participating in group counseling via a telehealth platform. It reviews the nature of online groups, confidentiality, safety, and the risks and benefits of these services. (0720)

Policy for Treating a Child of Divorced, Separated, or Unmarried Parents — This form outlines the terms and conditions when treating a child of divorced, separated, or unmarried parents. (0720)

Consent for Treatment Using Exposure Therapy — The purpose of this form is to request the client’s consent for exposure therapy treatment. (0720)

Consent to Use Touch in Therapy — This form allows a client to offer consent for the therapist to use touch in therapeutic work to benefit healing. (0720)

Consent to Record Therapy Session — This form allows the client to consent to recording of therapy sessions (audio or video). (0720)

Guest Therapy Consent — The purpose of this form is to allow a guest to participate in a therapy session as a third-party participant. (0720)

Client Rights — This form outlines client rights. (0720)

Child and Adolescent Counseling Agreement — This form is designed to be given to older children and adolescents at the beginning of counseling to orient them to the basic purposes of therapy. (0720)

Authorization to Use Unencrypted Email and Text — This document is to ensure clients are aware that email and/or text communications are not encrypted (coded) and therefore are not secure communications. (0720)

Agreement for Meetings with My Therapist — This form is intended to be used with older children or teens as a means to introduce the concept of confidentiality in therapy. (0720)

Acknowledgment of Receipt of Notice of Privacy Practices — This form indicates that a client has been offered a copy of the Notice of Privacy Practices that describes how information about the client may be used and disclosed, and how the client can access this information. (0720)

Informed Consent for Telehealth Services — This form can be used to get informed consent for telehealth services.(0320)

Informed Consent Form for Outpatient Services — This form can be modified for adult, children, and teen clients. Clinicians should modify the form to suit the needs of their practice.

Permission to Obtain or Release Confidential Information — This form can be used to obtain or release confidential information.

Drug Testing Consent Form — This form can be used to obtain consent for drug testing. The form should be modified to fit the needs of the individual therapist or clinic.

Authorization to Release Confidential Information to Family Members — This form can be used by clinicians to obtain consent to release of confidential information to family members. (0720)

Informed Consent for Group Therapy Sessions — This form covers services, appointments, fees, and more. Modify to fit your own needs.

Authorization to Release Confidential Information to Professionals — This form can be used by clinicians to obtain consent to release confidential information to other professionals. (0720)