Permissions
Information Sharing Consent Form

This form can be used by mental health professionals to get consent to share personal information, including health records, with others. (0522, practice management forms, confidentiality, permission)

Authorization to Use Appointment Reminders

This practice management form authorizes the therapists to use either text or phone appointment reminders. (0122, practice management, forms)

Professional Will

This form helps professionals plan for how their practice will be handled in the event of their death or inability to continue as a professional. It is designed to be a template for a professional to think about how others might handle patient records, passwords, patient referrals, and more. (0421, liability, practice management)

Responsibility Release (Client Self-Discharge)

This form can be used when a client chooses to terminate treatment against the advice of the therapist. (0720)

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)

Request for Restriction on Use/Disclosure of Protected Health Information

This form is used by clients to request restriction on use of protected health information. (0720)

Consent for Treatment Using Exposure Therapy

The purpose of this form is to request the client’s consent for exposure therapy treatment. (0720)

Request to Access Records

This form is used by clients to request copies of their own records. (0720)

Electronic Communication Policy

This form outlines the policy for electronic communication to ensure the security and confidentiality of treatment and to make sure it is consistent with ethics and laws. (0720)