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    Client Consent Form

    Uploaded by

    aryan batra
    The document outlines the counseling process and policies of a therapist including confidentiality, exceptions, payments, cancellations and termination. Sessions will last 50 minutes and frequency will depend on client needs. The therapist may recommend clinical evaluation and referrals but final decisions remain with the client.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Client Consent Form

    Uploaded by

    aryan batra
    34 views3 pages
    The document outlines the counseling process and policies of a therapist including confidentiality, exceptions, payments, cancellations and termination. Sessions will last 50 minutes and frequency will depend on client needs. The therapist may recommend clinical evaluation and referrals but final decisions remain with the client.

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    Client consent form

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    © © All Rights Reserved

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    The document outlines the counseling process and policies of a therapist including confidentiality, exceptions, payments, cancellations and termination. Sessions will last 50 minutes and frequency will depend on client needs. The therapist may recommend clinical evaluation and referrals but final decisions remain with the client.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    34 views3 pages

    Client Consent Form

    Uploaded by

    aryan batra
    The document outlines the counseling process and policies of a therapist including confidentiality, exceptions, payments, cancellations and termination. Sessions will last 50 minutes and frequency will depend on client needs. The therapist may recommend clinical evaluation and referrals but final decisions remain with the client.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
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    Client Consent Form

    The following form contains information about my professional practice and policies. It will give
    you an idea of how I work. Upon signing of the form you agree to the policies and procedures that I
    follow. In case you have any queries, feel free to discuss them with me.

    Counselling Process

    Counselling is a goal directed and confidential process where the therapist helps the client address
    their concerns, learn effective coping strategies and successfully reach their desired goal.

    Therapy differs for every client based on the concerns they come with and the modality the therapist
    utilises. In the first few sessions we will evaluate your problem and needs. We will discuss what you
    expect out of the process, your goals and requirements. Each session will last for 50 minutes and the
    frequency of sessions can vary according to the client’s needs. Since every client comes with unique
    concerns and goals, the length of treatment also differs accordingly.

    I may recommend you for a clinical evaluation, if referral to a psychiatrist or clinician for
    assessment is required in the case. The choice to follow through remains with you as do the
    consequences of choices related to taking or not taking the prescribed medications.

    Confidentiality

    Whatever we discuss during the session, records, progress, and any other type of content will be
    kept strictly confidential. You are guaranteed full privacy of our conversations. Any records will be
    kept in password protected devices. I may consult with other professionals in the team for best
    course of therapy.

    Exceptions to Confidentiality

    Disclosure may be required if:


    • There are reasonable grounds to believe that there is imminent danger or harm to the client or
    others. The therapist would be required to contact the client’s emergency contact to ensure safety.
    • There are reasonable grounds to believe that the client (a minor) is a victim of sexual abuse. The
    therapist is compelled by the Protection of Children from Sexual Offences Act, 2012 (POCSO) to
    inform the authorities.
    • Ordered by a court of law or any equivalent authority.
    Payment and Cancellation Policy

    Online bank transfer is the accepted mode of payment which is to be made 24 hours before the
    session. Your session will be scheduled only upon confirmation of the payment.

    Cancellations or reschedule are to be made 24 hours in advance and you will receive a full refund if
    made within the mentioned window. In case of late cancellations or reschedules, you will be
    charged fully.

    After starting the session, I will wait for 15 minutes from the scheduled time. If no contact has been
    made from your side (text, call or email), the session will be considered a no-show session and no
    reschedule or refunds will be provided. Please note this is only if no type of contact is made after
    the scheduled start time.

    Termination

    You can terminate therapy anytime. Although I encourage you to discuss the intentions and reasons
    with me first. Likewise I can terminate therapy upon providing reasonable grounds. Termination
    may be done when you and I feel that you have achieved your desired goals and can function
    without my guidance. We will continue having follow up sessions to ease the transition.
    Acknowledgement

    Name: Aryan Batra Contact Details: +91 8240658223

    Emergency contact name, number and relation with client: Jitendra Batra (Father), no: +91
    9007502237

    I have read, fully understood and accepted the purpose, risks and benefits of counselling, the sharing
    of personal information, the nature and limits of confidentiality, and what is expected of me as a
    client. I accept to participate in the counselling process.

    _____________________________

    (Signature of Client/Guardian in case (Signature of Therapist) client


    is minor)
    ___________________________ 06/07/23

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