Get your Informed Consent for Therapy

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Practice or business name

Address

Phone

Contact email

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About this document

Nature of therapy

Confidentiality and its limits

Fees, sessions and cancellation

Contact between sessions and emergencies

Records, electronic communication and your rights

Consent

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These parts depend on your practice and where you work. Write your own wording, or leave a box empty and the form will keep a line for you to fill in later.

Confidentiality and its limits
Prompt: insert the exact limits that apply where you practise.

Fees, sessions and cancellation
Prompt: describe payment methods, late cancellation and missed appointment policy, and any insurance billing.

Contact between sessions and emergencies
Prompt: how clients reach you, expected response time, and what to do in an emergency. This service is not an emergency service.

Records, electronic communication and your rights
Prompt: how records are kept and for how long, how email/text/telehealth are used and their privacy risks, client access to records, how to raise a concern or complaint, and your licensing body contact.

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Paper size
US Letter   A4 (UK, Europe)

Files
Fillable PDF   Editable Word file

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