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Mindcare | Psychotherapy Consent

Mindcare Treatment Centre

Psychotherapy Informed Consent Form

Confidential Clinical Document | Individual In-Person Therapy

Please complete this form carefully. Read each section before confirming your consent. Fields marked * are required.

Client Information

1. Purpose and Nature of Psychotherapy

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.

2. Client Rights and Voluntary Participation

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.

3. Confidentiality and Privacy

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:

  • Required by law or a valid court order.
  • Necessary to prevent a likelihood of serious harm to myself or another person.
  • Required or permitted for safeguarding a child or vulnerable person.
  • Necessary for appropriate clinical consultation, supervision, or referral, within applicable requirements.
  • Authorized by me through appropriate consent.

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.

4. Professional Boundaries and Communication

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.

5. Psychological Screening and Assessment

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.

6. Fees and Prepaid Therapy Packages

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.

7. Consent to Treatment

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.

Mindcare Treatment Centre | Confidential Clinical Document
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