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Counseling Informed Consent
Establish client rights, responsibilities, and confidentiality with this Counseling Informed Consent Template.
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Counseling Informed Consent Template
This 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.”
1. Purpose of Counseling
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.
2. Confidentiality
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.
3. Risks and Benefits
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.
4. Session Details and 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.
5. Client Rights
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.
6. Counselor Responsibilities
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.
7. Emergencies
Clients experiencing crises outside of session times should call [Emergency Hotline Number] or 911. The Counselor may provide referrals to additional resources as appropriate.
8. Acknowledgment
By signing below, the Client confirms that they understand the counseling process, confidentiality terms, risks, benefits, and financial obligations, and consent to participate.
Signatures
Counselor: ____________________________ Date: _________
Name/Title: _________________________________________
Client: ____________________________ Date: _________
Name: ______________________________________________
Details
Learn more about
Counseling Informed Consent
COUNSELING INFORMED CONSENT FAQ
What is a Counseling Informed Consent?
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.
Why is Counseling Informed Consent important?
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.
When should you use Counseling Informed Consent?
Use it before starting any counseling or therapy services, whether individual, couples, or family sessions, to comply with professional ethics and legal standards.
What should Counseling Informed Consent include?
It should cover counselor credentials, scope of services, confidentiality limits, risks and benefits, session fees, cancellation policies, and procedures for emergencies or complaints.
Is Counseling Informed Consent legally binding?
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.
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