Scribd Logo
Upload

Welcome to Scribd!

  • 1K views

    Informed Consent Form

    Uploaded by

    Saroja Roy
    This document outlines an informed consent form for psychotherapy. It contains 3 main sections: [1] an overview of what psychotherapy entails, including understanding the client's background and agreeing on treatment goals; [2] a statement noting the psychotherapist is not responsible for adverse events and may recommend other treatment; and [3] details on confidentiality, storage of session notes, and prohibiting recording or sharing of session contents without consent. The client provides contact information and signs the form, indicating understanding and consent for the psychotherapy sessions.

    Copyright:

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

    Informed Consent Form

    Uploaded by

    Saroja Roy
    1K views2 pages
    This document outlines an informed consent form for psychotherapy. It contains 3 main sections: [1] an overview of what psychotherapy entails, including understanding the client's background and agreeing on treatment goals; [2] a statement noting the psychotherapist is not responsible for adverse events and may recommend other treatment; and [3] details on confidentiality, storage of session notes, and prohibiting recording or sharing of session contents without consent. The client provides contact information and signs the form, indicating understanding and consent for the psychotherapy sessions.

    Original Title

    Consent Form

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document outlines an informed consent form for psychotherapy. It contains 3 main sections: [1] an overview of what psychotherapy entails, including understanding the client's background and agreeing on treatment goals; [2] a statement noting the psychotherapist is not responsible for adverse events and may recommend other treatment; and [3] details on confidentiality, storage of session notes, and prohibiting recording or sharing of session contents without consent. The client provides contact information and signs the form, indicating understanding and consent for the psychotherapy sessions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    1K views2 pages

    Informed Consent Form

    Uploaded by

    Saroja Roy
    This document outlines an informed consent form for psychotherapy. It contains 3 main sections: [1] an overview of what psychotherapy entails, including understanding the client's background and agreeing on treatment goals; [2] a statement noting the psychotherapist is not responsible for adverse events and may recommend other treatment; and [3] details on confidentiality, storage of session notes, and prohibiting recording or sharing of session contents without consent. The client provides contact information and signs the form, indicating understanding and consent for the psychotherapy sessions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    INFORMED CONSENT FORM

    CLIENT INFORMED CONSENT FORM


    Informed consent for consultation with Clinical Psychologists 1 for psychotherapy at
    School of Criminology and Behavioural Sciences (SCBS), Rashtriya Raksha University.

    General Information provided to me -


    Psychotherapy:
    Psychotherapy is a way to help people experiencing significant emotional distress that is
    coming in the way of them being physically well, enjoying personal relationships, or working
    productively. Psychotherapy begins with the therapist understanding the background of the
    person seeking help2 and the concerns that led them to seek help. Following this, the client and
    psychotherapist come to an agreement about the goals of treatment, treatment procedures, and
    a regular schedule for the time, place, and duration of their treatment sessions.

    Responsibility for adverse events:


    I understand that the psychotherapist would use their professional discretion to provide required
    recommendations about the type of professional service that may be required at any given point
    of time. At the same time, I agree to not hold my psychotherapist responsible, should any
    adverse events, such as lack of improvement, deterioration, or situations of the potential risk of
    harm to self or others, occur during video/ audio consultation. I understand that in such
    situations I may be advised to obtain treatment at the nearest available mental health or
    emergency service.

    Confidentiality and Recording:


    I understand that this consultation is strictly confidential. I understand that my psychotherapist
    will not audio or video record the session and will not share the proceedings of this consultation
    with any other individual or agency. However, with my consent, my psychotherapist could use
    it to have their work supervised or for the training of professionals. Apart from this, the details
    of the consultation would be shared only with a court of law, if mandated.

    1
    Herewith mentioned as ‘Psychotherapist’ in this Informed Consent Form
    2
    Herewith referred to as ‘Client’ in this Informed Consent Form
    Notes of the consultation will be maintained by my psychotherapist and stored in a safe
    location. I understand that these session notes can be made available to me, in the standard
    session record format, on my explicit request.

    I also undertake that the proceedings of these consultations are not to be recorded, shared or
    disseminated by me or my relatives / other contacts to any third person.

    Consent:
    I hereby provide my informed consent for consultations for psychotherapy at School of
    Criminology and Behavioural Sciences (SCBS), Rashtriya Raksha University.

    Contact information
    My current residential address and phone number:

    _______________________________________________________________________

    The contents of this form have been explained to me in a language that I understand.
    After reading/listening to and understanding all of the above, I am giving my consent for:

    By returning this form, I indicate consent for the sessions.

    Name & Signature: Date:

    You might also like