Counseling Informed Consent

Client's Rights

The client may ask questions on what to expect during and end result of the therapy.
The client may decline to proceed the therapy as to the techniques which may be conducted by the therapist.
The client may cease to continue therapy anytime, without any impediment and may return to therapy anytime.
The therapist has the right to dismiss the client from the course of therapy.
The client has the right to review his or her records from the therapist.
Right to confidentiality: Within limits provided for by law, all records and information acquired by the therapist shall be kept strictly confidential in accordance to the principles of a doctor-patient relationship. All information will not be shared or revealed to any person, agency, or organization without the prior written consent of the client.
The client can raise any concerns and to speak with the therapist immediately of any concerns provided that the therapist is likewise available to discuss matters with the client.

Please check the items that you believe are affecting you

Client name

First

Last name *

Last

Email *

Phone *

Address

City

State/Province

Zip/Postal

Country

Date

Time

:

Acknowledgement *

I have reviewed this Professional Counseling Informed Consent Agreement. I likewise understand my Client's Rights set in this form.

I accept this agreement and consent to counseling

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