Consent
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)