Art Therapy Informed Consent Form

Captures a participant's, or guardian's, informed consent before starting art therapy sessions.

Use this template

Art Therapy Clinic Name

Therapist Name

Session Date

Diagnosis or Reason for Referral

Estimated Treatment Duration

Consent Statement

Please Select an Option

I Consent I Do Not Consent

Participant's Name

First Name

Last Name

Participant's Signature

Sign here

Date

Name of Parent or Guardian

First Name

Last Name

Signature of Parent or Guardian

Sign here

Date

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