Counseling Informed Consent Form

Inform the client about the purpose, confidentiality limits, and policies of the therapeutic process before sessions begin.

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Purpose of Counseling Services

Confidentiality and Its Limits

Risks and Benefits of Counseling

Appointments and Cancellation Policy

Fees and Payment

Client Rights and Responsibilities

Consent to Treatment

Age of Consent

I am an adult (18 or older) I am a minor (parent/guardian signature required)

Name

Nombre

Apellido

Signature

Sign here

Date

Parent/Guardian

Nombre

Apellido

Signature of Parent/Guardian

Sign here

Date

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