Please enable JavaScript in your browser to complete this form.

PURPOSE: The purpose of the consent form is to gain the patient's consent in order to participate in treatment appointments.

HEALTH INFORMATION: The medical information related to history, records and tests of the patient will be discussed during the appointment and treatment.

PATIENT RIGHTS: The patient can withdraw his/her consent at any time and can ask the questions related to appointments and treatment.

Client's Name
Address
Informed Consent
I understand that all the laws that are protecting my privacy of medical history or information are also applied to these practices. I understand that I can withdraw the consent at any time and that will not affect any of my future treatment procedures. I understand that I can be charged the additional fees that my insurance does not cover. I accept that I authorize health care professionals for my treatment and diagnosis.
Clear Signature
Clear Signature

As a counselor, ensuring that your clients are well-informed about their rights and responsibilities is not just good practice, but essential for ethical standards and compliance.

That’s where our Counseling Informed Consent Form Template comes in. Get it for your website today!

Why Do I Need the Counseling Informed Consent Form Template?

These are just a handful of the ways this consent form can benefit your organization and website:

  • Protection of Client Privacy: By explicitly stating that the same laws protecting medical privacy apply to counseling practices, clients are reassured of the confidentiality of their information.
  • Clear Terms of Consent: The consent form outlines the client’s right to withdraw consent at any time without affecting future treatment, so they feel empowered throughout the counseling process.
  • Financial Transparency: Clients are made aware that they may be responsible for fees not covered by insurance, promoting financial transparency and preventing misunderstandings down the line.
  • Authorization for Treatment: The consent form solidifies the client’s authorization for healthcare professionals to provide treatment and diagnosis, which establishes clear boundaries and expectations.

Plus, our Counseling Informed Consent Form Template comes with the Save and Resume addon built into it. This means that counselors and clients can provide their signatures at different times and from different devices if needed.

This consent form is not just a formality, but a foundational tool for ethical and effective counseling practices. So don’t miss out on this necessary addition to your site! Sign up with WPForms to access the Counseling Informed Consent Form Template and thousands of other templates for your website.