Counseling Informed Consent Form

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

Use this template

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

First Name

Last Name

Signature

Sign here

Date

Parent/Guardian

First Name

Last Name

Signature of Parent/Guardian

Sign here

Date

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