Psychotherapy Informed Consent Form
Confidential Clinical Document | Individual In-Person Therapy
Psychotherapy is a collaborative process that supports emotional wellbeing, psychological adjustment, coping skills, and personal growth. Sessions may include therapeutic discussions, psychoeducation, cognitive and behavioural interventions, and psychological screening where clinically appropriate.
I understand that therapy outcomes vary and no specific result is guaranteed.
I understand that participation is voluntary. I have the right to ask questions, participate in treatment planning, express concerns, decline to answer questions where appropriate, request referral, and discuss ending therapy.
Information shared during therapy and clinical records will be treated as confidential and handled in accordance with applicable professional, ethical, and legal requirements.
Confidentiality may be limited where disclosure is:
Mindcare may collect and process relevant personal and clinical information for the provision and administration of care. Information should be handled in accordance with applicable data protection requirements and Mindcare's privacy practices.
Psychotherapy is a professional relationship. Appropriate boundaries will be maintained regarding communication, appointments, and contact outside sessions. Routine communication is not an emergency service. Emergency assistance should be sought from an appropriate emergency service or healthcare provider when immediate support is required.
Where appropriate, psychological screening or assessment may be recommended to inform treatment planning. I understand that screening does not necessarily constitute a diagnosis and that results will be interpreted within their limitations.
I understand that payment terms, cancellations, rescheduling, refunds, expiry, and additional services will be communicated and agreed before or at the time of purchase. Prepaid packages do not guarantee a particular clinical outcome. Treatment recommendations may be reviewed according to my clinical needs and progress.
Please confirm each statement before signing.
Therapist signature: To be completed by the therapist through an approved signing process or on the retained clinical record.