Introducing Referent – AI-native practice management software for modern law firms.
Explore ReferentThis Counseling Informed Consent (“Agreement”) is entered into on [Date], by and between:
Counselor: [Full Name, Credentials, License Number, Practice Address]
Client: [Full Legal Name, Address, Contact Information]
Together referred to as the “Parties.”
Counseling is a collaborative process intended to support personal growth, emotional well-being, and problem-solving. The Counselor will provide services using appropriate therapeutic methods and professional standards.
All client information will be kept confidential except as required by law (e.g., threats of harm, child abuse, court orders).
Records will be securely stored and only shared with written client consent.
All client information will be kept confidential except as required by law (e.g., threats of harm, child abuse, court orders).
Records will be securely stored and only shared with written client consent.
Counseling may involve discussing sensitive issues that can trigger emotional discomfort.
Benefits may include improved coping skills, self-awareness, and healthier relationships.
No guarantees of specific outcomes can be made.
Counseling may involve discussing sensitive issues that can trigger emotional discomfort.
Benefits may include improved coping skills, self-awareness, and healthier relationships.
No guarantees of specific outcomes can be made.
Session length: [e.g., 50 minutes]
Fee per session: $[Amount]
Payment is due [at time of service / monthly]
Missed sessions or cancellations with less than [X hours] notice may incur fees.
Session length: [e.g., 50 minutes]
Fee per session: $[Amount]
Payment is due [at time of service / monthly]
Missed sessions or cancellations with less than [X hours] notice may incur fees.
Clients have the right to:
Ask questions about treatment methods.
Decline specific interventions.
Request referral to another professional.
End counseling at any time, subject to financial obligations for services already rendered.
Ask questions about treatment methods.
Decline specific interventions.
Request referral to another professional.
End counseling at any time, subject to financial obligations for services already rendered.
The Counselor agrees to:
Provide services in accordance with professional ethical standards.
Maintain licensure and professional competency.
Respect the client’s dignity, autonomy, and values.
Provide services in accordance with professional ethical standards.
Maintain licensure and professional competency.
Respect the client’s dignity, autonomy, and values.
Clients experiencing crises outside of session times should call [Emergency Hotline Number] or 911. The Counselor may provide referrals to additional resources as appropriate.
By signing below, the Client confirms that they understand the counseling process, confidentiality terms, risks, benefits, and financial obligations, and consent to participate.
Counselor: ____________________________ Date: _________
Name/Title: _________________________________________
Client: ____________________________ Date: _________
Name: ______________________________________________
Each template already follows legal structure and best practices.
The agreement is automatically filled and adapted to your inputs.
Check the generated document, make edits if needed, and download a ready-to-use agreement.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Frequently asked
It is a document that outlines the counseling process, including confidentiality, risks, benefits, fees, and client rights. Clients review and sign it before beginning therapy to show understanding and agreement.
It ensures transparency, builds trust, and provides legal protection. It also helps clients make informed decisions about their participation, knowing the limits of confidentiality and the scope of services.
Use it before starting any counseling or therapy services, whether individual, couples, or family sessions, to comply with professional ethics and legal standards.
It should cover counselor credentials, scope of services, confidentiality limits, risks and benefits, session fees, cancellation policies, and procedures for emergencies or complaints.
Yes. While it functions primarily as an ethical and professional safeguard, it is also a legal document confirming that the client understands and agrees to the counseling process.
Use our AI-powered builder to generate a tailored Counseling Informed Consent in minutes — professional, client-focused, and compliant with ethical standards.
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