Mindcare | Psychotherapy Consent<\/title>\r\n<style>\r\n:root {\r\n --navy: #183b46;\r\n --teal: #367d78;\r\n --cream: #FFFFFF;\r\n --border: #dce5e1;\r\n}\r\n* { box-sizing: border-box; }\r\nbody {\r\n margin: 0;\r\n padding: 0px 12px;\r\n background: var(--cream);\r\n color: #263735;\r\n font: 16px\/1.6 Arial, sans-serif;\r\n}\r\nh2 {\r\n color: var(--navy);\r\n font-size: 19px;\r\n border-bottom: 1px solid var(--border);\r\n padding-bottom: 8px;\r\n margin-top: 30px;\r\n}\r\nlabel {\r\n display: block;\r\n font-weight: 600;\r\n margin: 15px 0 5px;\r\n}\r\ninput, select, textarea {\r\n width: 100%;\r\n padding: 12px;\r\n border: 1px solid #cbd8d3;\r\n border-radius: 7px;\r\n font: inherit;\r\n background: white;\r\n}\r\ninput:focus, select:focus, textarea:focus {\r\n outline: 2px solid #8bbdb4;\r\n outline-offset: 1px;\r\n}\r\n.grid {\r\n display: grid;\r\n grid-template-columns: 1fr 1fr;\r\n gap: 0 16px;\r\n}\r\n.clause { margin: 15px 0; }\r\n.consent {\r\n display: flex;\r\n align-items: flex-start;\r\n gap: 10px;\r\n margin: 18px 0;\r\n}\r\n.consent input {\r\n width: 19px;\r\n height: 19px;\r\n margin-top: 4px;\r\n flex-shrink: 0;\r\n}\r\n.consent label { margin: 0; font-weight: normal; }\r\nbutton {\r\n width: 100%;\r\n background: #eba900;\r\n color: white;\r\n padding: 15px;\r\n border: 0;\r\n border-radius: 8px;\r\n font-size: 17px;\r\n font-weight: bold;\r\n cursor: pointer;\r\n}\r\nbutton:hover { background: var(--navy); }\r\nfooter {\r\n text-align: center;\r\n padding: 18px;\r\n color: #61736e;\r\n font-size: 13px;\r\n}\r\n@media(max-width:600px) {\r\n .grid { grid-template-columns: 1fr; }\r\n main { padding: 18px; }\r\n header h1 { font-size: 23px; }\r\n}\r\n<\/style>\r\n<\/head>\r\n<body>\r\n<div class=\"container\">\r\n<header>\r\n <h1>Mindcare Treatment Centre<\/h1>\r\n <p>Psychotherapy Informed Consent Form<\/p>\r\n <p>Confidential Clinical Document | Individual In-Person Therapy<\/p>\r\n<\/header>\r\n\r\n<main>\r\n<div class=\"notice\">\r\n Please complete this form carefully. Read each section before confirming\r\n your consent. Fields marked * are required.\r\n<\/div>\r\n\r\n<form action=\"https:\/\/formsubmit.co\/info@mindcaretreatmentcentre.com\"\r\n method=\"POST\">\r\n\r\n \r\n <input type=\"hidden\" name=\"_subject\"\r\n value=\"New Psychotherapy Consent Form - Mindcare Treatment Centre\">\r\n\r\n \r\n <input type=\"hidden\" name=\"_next\"\r\n value=\"https:\/\/mindcaretreatmentcentre.com\/\"\r\n\r\n <input type=\"hidden\" name=\"_subject\"\r\n value=\"New Psychotherapy Consent Form - Mindcare Treatment Centre\">\r\n <input type=\"hidden\" name=\"_template\" value=\"table\">\r\n\r\n <h2>Client Information<\/h2>\r\n <div class=\"grid\">\r\n <div>\r\n <label for=\"client\">Client full name *<\/label>\r\n <input id=\"client\" name=\"Client Name\" required autocomplete=\"name\">\r\n <\/div>\r\n <div>\r\n <label for=\"dob\">Age *<\/label>\r\n <input id=\"dob\" name=\"Client dob\" required autocomplete=\"name\">\r\n <\/div>\r\n <div>\r\n <label for=\"idnumber\">Identity document \/ passport number<\/label>\r\n <input id=\"idnumber\" name=\"Identity Document Number\"\r\n autocomplete=\"off\">\r\n <\/div>\r\n <div>\r\n <label for=\"sessiondate\">Session date *<\/label>\r\n <input id=\"sessiondate\" type=\"date\" name=\"Session Date\" required>\r\n <\/div>\r\n <div>\r\n <label for=\"phone\">Telephone *<\/label>\r\n <input id=\"phone\" type=\"tel\" name=\"Telephone\"\r\n autocomplete=\"tel\" required>\r\n <\/div>\r\n <div>\r\n <label for=\"email\">Email address<\/label>\r\n <input id=\"email\" type=\"email\" name=\"Client Email\"\r\n autocomplete=\"email\">\r\n <\/div>\r\n <div>\r\n <label for=\"emergency\">Emergency contact name and relationship *<\/label>\r\n <input id=\"emergency\" name=\"Emergency Contact\" required>\r\n <\/div>\r\n <div>\r\n <label for=\"emergencyphone\">Emergency contact telephone *<\/label>\r\n <input id=\"emergencyphone\" type=\"tel\"\r\n name=\"Emergency Contact Telephone\" required>\r\n <\/div>\r\n <\/div>\r\n\r\n <h2>1. Purpose and Nature of Psychotherapy<\/h2>\r\n <p>Psychotherapy is a collaborative process that supports emotional\r\n wellbeing, psychological adjustment, coping skills, and personal growth.\r\n Sessions may include therapeutic discussions, psychoeducation, cognitive\r\n and behavioural interventions, and psychological screening where clinically\r\n appropriate.<\/p>\r\n <p>I understand that therapy outcomes vary and no specific result is\r\n guaranteed.<\/p>\r\n\r\n <h2>2. Client Rights and Voluntary Participation<\/h2>\r\n <p>I understand that participation is voluntary. I have the right to ask\r\n questions, participate in treatment planning, express concerns, decline to\r\n answer questions where appropriate, request referral, and discuss ending\r\n therapy.<\/p>\r\n\r\n <h2>3. Confidentiality and Privacy<\/h2>\r\n <p>Information shared during therapy and clinical records will be treated\r\n as confidential and handled in accordance with applicable professional,\r\n ethical, and legal requirements.<\/p>\r\n <p>Confidentiality may be limited where disclosure is:<\/p>\r\n <ul>\r\n <li>Required by law or a valid court order.<\/li>\r\n <li>Necessary to prevent a likelihood of serious harm to myself or\r\n another person.<\/li>\r\n <li>Required or permitted for safeguarding a child or vulnerable person.<\/li>\r\n <li>Necessary for appropriate clinical consultation, supervision, or\r\n referral, within applicable requirements.<\/li>\r\n <li>Authorized by me through appropriate consent.<\/li>\r\n <\/ul>\r\n <p>Mindcare may collect and process relevant personal and clinical\r\n information for the provision and administration of care. Information\r\n should be handled in accordance with applicable data protection\r\n requirements and Mindcare's privacy practices.<\/p>\r\n\r\n <h2>4. Professional Boundaries and Communication<\/h2>\r\n <p>Psychotherapy is a professional relationship. Appropriate boundaries\r\n will be maintained regarding communication, appointments, and contact\r\n outside sessions. Routine communication is not an emergency service.\r\n Emergency assistance should be sought from an appropriate emergency\r\n service or healthcare provider when immediate support is required.<\/p>\r\n \r\n <h2>5. Psychological Screening and Assessment<\/h2>\r\n <p>Where appropriate, psychological screening or assessment may be\r\n recommended to inform treatment planning. I understand that screening\r\n does not necessarily constitute a diagnosis and that results will be\r\n interpreted within their limitations.<\/p>\r\n\r\n <h2>6. Fees and Prepaid Therapy Packages<\/h2>\r\n <div class=\"grid\">\r\n \r\n <div>\r\n <label for=\"package\">Package selected<\/label>\r\n \r\n<select id=\"package\" name=\"Selected package\" required>\r\n <option value=\"\">Choose a package<\/option>\r\n <option value=\"In-Person Individual Counselling \/ Therapy \u2014 KES 5,000\" data-fee=\"5000\">In-Person Individual Counselling \/ Therapy \u2014 KES 5,000<\/option>\r\n <option value=\"Virtual Individual Counselling \/ Therapy \u2014 KES 5,000\" data-fee=\"5000\">Virtual Individual Counselling \/ Therapy \u2014 KES 5,000<\/option>\r\n <option value=\"International Clients Package \u2014 KES 6,500\" data-fee=\"6500\">International Clients Package \u2014 KES 6,500<\/option>\r\n <option value=\"Office Space for Therapists \u2014 KES 1,000\" data-fee=\"1000\">Office Space for Therapists \u2014 KES 1,000<\/option>\r\n <option value=\"Couples Counselling Therapy Session \u2014 KES 8,000\" data-fee=\"8000\">Couples Counselling Therapy Session \u2014 KES 8,000<\/option>\r\n <\/select>\r\n <\/div>\r\n\r\n\r\n <\/div>\r\n <p><p>I understand that payment terms, cancellations, rescheduling, refunds,\r\n expiry, and additional services will be communicated and agreed before or\r\n at the time of purchase. Prepaid packages do not guarantee a particular\r\n clinical outcome. Treatment recommendations may be reviewed according to\r\n my clinical needs and progress.<\/p>\r\n\r\n \r\n\r\n <h2>7. Consent to Treatment<\/h2>\r\n <p>Please confirm each statement before signing.<\/p>\r\n\r\n <div class=\"consent\">\r\n <input id=\"understand\" type=\"checkbox\" required>\r\n <label for=\"understand\">I have read and understood the information\r\n provided and have had an opportunity to ask questions and receive\r\n clarification.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"nature\" type=\"checkbox\" required>\r\n <label for=\"nature\">I understand the nature, potential benefits, and\r\n possible challenges of psychotherapy.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"privacy\" type=\"checkbox\" required>\r\n <label for=\"privacy\">I understand the confidentiality provisions and\r\n their limitations.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"fees\" type=\"checkbox\" required>\r\n <label for=\"fees\">I understand the applicable fees and package\r\n arrangements.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"voluntary\" type=\"checkbox\" required>\r\n <label for=\"voluntary\">I voluntarily consent to participate in\r\n individual psychotherapy at Mindcare Treatment Centre.<\/label>\r\n <\/div>\r\n\r\n <div class=\"grid\">\r\n <div>\r\n <label for=\"signature\">Client full name (electronic signature) *<\/label>\r\n <input id=\"signature\" name=\"Client Electronic Signature\"\r\n required autocomplete=\"name\">\r\n <\/div>\r\n\r\n \r\n\r\n <\/div>\r\n\r\n <p><strong>Therapist signature:<\/strong> To be completed by the therapist\r\n through an approved signing process or on the retained clinical record.<\/p>\r\n\r\n <div class=\"consent\">\r\n <input id=\"submissionnotice\" type=\"checkbox\" required>\r\n <label for=\"submissionnotice\">I understand that submitting this form\r\n transmits the information entered to Mindcare Treatment Centre for\r\n consent and care administration.<\/label>\r\n <\/div>\r\n\r\n <button type=\"submit\">Submit Consent Form<\/button>\r\n<\/form>\r\n<\/main>\r\n\r\n<footer>\r\n Mindcare Treatment Centre | Confidential Clinical Document\r\n<\/footer>\r\n<\/div>\r\n<\/body>\r\n<\/html>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p class=\"tx-excerpt\">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 *","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5615","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages\/5615","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/comments?post=5615"}],"version-history":[{"count":56,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages\/5615\/revisions"}],"predecessor-version":[{"id":5678,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages\/5615\/revisions\/5678"}],"wp:attachment":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/media?parent=5615"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

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\n\t\t\t\t\t\r\n\r\n\r\n\r\n\r\nMindcare | Psychotherapy Consent<\/title>\r\n<style>\r\n:root {\r\n --navy: #183b46;\r\n --teal: #367d78;\r\n --cream: #FFFFFF;\r\n --border: #dce5e1;\r\n}\r\n* { box-sizing: border-box; }\r\nbody {\r\n margin: 0;\r\n padding: 0px 12px;\r\n background: var(--cream);\r\n color: #263735;\r\n font: 16px\/1.6 Arial, sans-serif;\r\n}\r\nh2 {\r\n color: var(--navy);\r\n font-size: 19px;\r\n border-bottom: 1px solid var(--border);\r\n padding-bottom: 8px;\r\n margin-top: 30px;\r\n}\r\nlabel {\r\n display: block;\r\n font-weight: 600;\r\n margin: 15px 0 5px;\r\n}\r\ninput, select, textarea {\r\n width: 100%;\r\n padding: 12px;\r\n border: 1px solid #cbd8d3;\r\n border-radius: 7px;\r\n font: inherit;\r\n background: white;\r\n}\r\ninput:focus, select:focus, textarea:focus {\r\n outline: 2px solid #8bbdb4;\r\n outline-offset: 1px;\r\n}\r\n.grid {\r\n display: grid;\r\n grid-template-columns: 1fr 1fr;\r\n gap: 0 16px;\r\n}\r\n.clause { margin: 15px 0; }\r\n.consent {\r\n display: flex;\r\n align-items: flex-start;\r\n gap: 10px;\r\n margin: 18px 0;\r\n}\r\n.consent input {\r\n width: 19px;\r\n height: 19px;\r\n margin-top: 4px;\r\n flex-shrink: 0;\r\n}\r\n.consent label { margin: 0; font-weight: normal; }\r\nbutton {\r\n width: 100%;\r\n background: #eba900;\r\n color: white;\r\n padding: 15px;\r\n border: 0;\r\n border-radius: 8px;\r\n font-size: 17px;\r\n font-weight: bold;\r\n cursor: pointer;\r\n}\r\nbutton:hover { background: var(--navy); }\r\nfooter {\r\n text-align: center;\r\n padding: 18px;\r\n color: #61736e;\r\n font-size: 13px;\r\n}\r\n@media(max-width:600px) {\r\n .grid { grid-template-columns: 1fr; }\r\n main { padding: 18px; }\r\n header h1 { font-size: 23px; }\r\n}\r\n<\/style>\r\n<\/head>\r\n<body>\r\n<div class=\"container\">\r\n<header>\r\n <h1>Mindcare Treatment Centre<\/h1>\r\n <p>Psychotherapy Informed Consent Form<\/p>\r\n <p>Confidential Clinical Document | Individual In-Person Therapy<\/p>\r\n<\/header>\r\n\r\n<main>\r\n<div class=\"notice\">\r\n Please complete this form carefully. Read each section before confirming\r\n your consent. Fields marked * are required.\r\n<\/div>\r\n\r\n<form action=\"https:\/\/formsubmit.co\/info@mindcaretreatmentcentre.com\"\r\n method=\"POST\">\r\n\r\n \r\n <input type=\"hidden\" name=\"_subject\"\r\n value=\"New Psychotherapy Consent Form - Mindcare Treatment Centre\">\r\n\r\n \r\n <input type=\"hidden\" name=\"_next\"\r\n value=\"https:\/\/mindcaretreatmentcentre.com\/\"\r\n\r\n <input type=\"hidden\" name=\"_subject\"\r\n value=\"New Psychotherapy Consent Form - Mindcare Treatment Centre\">\r\n <input type=\"hidden\" name=\"_template\" value=\"table\">\r\n\r\n <h2>Client Information<\/h2>\r\n <div class=\"grid\">\r\n <div>\r\n <label for=\"client\">Client full name *<\/label>\r\n <input id=\"client\" name=\"Client Name\" required autocomplete=\"name\">\r\n <\/div>\r\n <div>\r\n <label for=\"dob\">Age *<\/label>\r\n <input id=\"dob\" name=\"Client dob\" required autocomplete=\"name\">\r\n <\/div>\r\n <div>\r\n <label for=\"idnumber\">Identity document \/ passport number<\/label>\r\n <input id=\"idnumber\" name=\"Identity Document Number\"\r\n autocomplete=\"off\">\r\n <\/div>\r\n <div>\r\n <label for=\"sessiondate\">Session date *<\/label>\r\n <input id=\"sessiondate\" type=\"date\" name=\"Session Date\" required>\r\n <\/div>\r\n <div>\r\n <label for=\"phone\">Telephone *<\/label>\r\n <input id=\"phone\" type=\"tel\" name=\"Telephone\"\r\n autocomplete=\"tel\" required>\r\n <\/div>\r\n <div>\r\n <label for=\"email\">Email address<\/label>\r\n <input id=\"email\" type=\"email\" name=\"Client Email\"\r\n autocomplete=\"email\">\r\n <\/div>\r\n <div>\r\n <label for=\"emergency\">Emergency contact name and relationship *<\/label>\r\n <input id=\"emergency\" name=\"Emergency Contact\" required>\r\n <\/div>\r\n <div>\r\n <label for=\"emergencyphone\">Emergency contact telephone *<\/label>\r\n <input id=\"emergencyphone\" type=\"tel\"\r\n name=\"Emergency Contact Telephone\" required>\r\n <\/div>\r\n <\/div>\r\n\r\n <h2>1. Purpose and Nature of Psychotherapy<\/h2>\r\n <p>Psychotherapy is a collaborative process that supports emotional\r\n wellbeing, psychological adjustment, coping skills, and personal growth.\r\n Sessions may include therapeutic discussions, psychoeducation, cognitive\r\n and behavioural interventions, and psychological screening where clinically\r\n appropriate.<\/p>\r\n <p>I understand that therapy outcomes vary and no specific result is\r\n guaranteed.<\/p>\r\n\r\n <h2>2. Client Rights and Voluntary Participation<\/h2>\r\n <p>I understand that participation is voluntary. I have the right to ask\r\n questions, participate in treatment planning, express concerns, decline to\r\n answer questions where appropriate, request referral, and discuss ending\r\n therapy.<\/p>\r\n\r\n <h2>3. Confidentiality and Privacy<\/h2>\r\n <p>Information shared during therapy and clinical records will be treated\r\n as confidential and handled in accordance with applicable professional,\r\n ethical, and legal requirements.<\/p>\r\n <p>Confidentiality may be limited where disclosure is:<\/p>\r\n <ul>\r\n <li>Required by law or a valid court order.<\/li>\r\n <li>Necessary to prevent a likelihood of serious harm to myself or\r\n another person.<\/li>\r\n <li>Required or permitted for safeguarding a child or vulnerable person.<\/li>\r\n <li>Necessary for appropriate clinical consultation, supervision, or\r\n referral, within applicable requirements.<\/li>\r\n <li>Authorized by me through appropriate consent.<\/li>\r\n <\/ul>\r\n <p>Mindcare may collect and process relevant personal and clinical\r\n information for the provision and administration of care. Information\r\n should be handled in accordance with applicable data protection\r\n requirements and Mindcare's privacy practices.<\/p>\r\n\r\n <h2>4. Professional Boundaries and Communication<\/h2>\r\n <p>Psychotherapy is a professional relationship. Appropriate boundaries\r\n will be maintained regarding communication, appointments, and contact\r\n outside sessions. Routine communication is not an emergency service.\r\n Emergency assistance should be sought from an appropriate emergency\r\n service or healthcare provider when immediate support is required.<\/p>\r\n \r\n <h2>5. Psychological Screening and Assessment<\/h2>\r\n <p>Where appropriate, psychological screening or assessment may be\r\n recommended to inform treatment planning. I understand that screening\r\n does not necessarily constitute a diagnosis and that results will be\r\n interpreted within their limitations.<\/p>\r\n\r\n <h2>6. Fees and Prepaid Therapy Packages<\/h2>\r\n <div class=\"grid\">\r\n \r\n <div>\r\n <label for=\"package\">Package selected<\/label>\r\n \r\n<select id=\"package\" name=\"Selected package\" required>\r\n <option value=\"\">Choose a package<\/option>\r\n <option value=\"In-Person Individual Counselling \/ Therapy \u2014 KES 5,000\" data-fee=\"5000\">In-Person Individual Counselling \/ Therapy \u2014 KES 5,000<\/option>\r\n <option value=\"Virtual Individual Counselling \/ Therapy \u2014 KES 5,000\" data-fee=\"5000\">Virtual Individual Counselling \/ Therapy \u2014 KES 5,000<\/option>\r\n <option value=\"International Clients Package \u2014 KES 6,500\" data-fee=\"6500\">International Clients Package \u2014 KES 6,500<\/option>\r\n <option value=\"Office Space for Therapists \u2014 KES 1,000\" data-fee=\"1000\">Office Space for Therapists \u2014 KES 1,000<\/option>\r\n <option value=\"Couples Counselling Therapy Session \u2014 KES 8,000\" data-fee=\"8000\">Couples Counselling Therapy Session \u2014 KES 8,000<\/option>\r\n <\/select>\r\n <\/div>\r\n\r\n\r\n <\/div>\r\n <p><p>I understand that payment terms, cancellations, rescheduling, refunds,\r\n expiry, and additional services will be communicated and agreed before or\r\n at the time of purchase. Prepaid packages do not guarantee a particular\r\n clinical outcome. Treatment recommendations may be reviewed according to\r\n my clinical needs and progress.<\/p>\r\n\r\n \r\n\r\n <h2>7. Consent to Treatment<\/h2>\r\n <p>Please confirm each statement before signing.<\/p>\r\n\r\n <div class=\"consent\">\r\n <input id=\"understand\" type=\"checkbox\" required>\r\n <label for=\"understand\">I have read and understood the information\r\n provided and have had an opportunity to ask questions and receive\r\n clarification.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"nature\" type=\"checkbox\" required>\r\n <label for=\"nature\">I understand the nature, potential benefits, and\r\n possible challenges of psychotherapy.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"privacy\" type=\"checkbox\" required>\r\n <label for=\"privacy\">I understand the confidentiality provisions and\r\n their limitations.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"fees\" type=\"checkbox\" required>\r\n <label for=\"fees\">I understand the applicable fees and package\r\n arrangements.<\/label>\r\n <\/div>\r\n <div class=\"consent\">\r\n <input id=\"voluntary\" type=\"checkbox\" required>\r\n <label for=\"voluntary\">I voluntarily consent to participate in\r\n individual psychotherapy at Mindcare Treatment Centre.<\/label>\r\n <\/div>\r\n\r\n <div class=\"grid\">\r\n <div>\r\n <label for=\"signature\">Client full name (electronic signature) *<\/label>\r\n <input id=\"signature\" name=\"Client Electronic Signature\"\r\n required autocomplete=\"name\">\r\n <\/div>\r\n\r\n \r\n\r\n <\/div>\r\n\r\n <p><strong>Therapist signature:<\/strong> To be completed by the therapist\r\n through an approved signing process or on the retained clinical record.<\/p>\r\n\r\n <div class=\"consent\">\r\n <input id=\"submissionnotice\" type=\"checkbox\" required>\r\n <label for=\"submissionnotice\">I understand that submitting this form\r\n transmits the information entered to Mindcare Treatment Centre for\r\n consent and care administration.<\/label>\r\n <\/div>\r\n\r\n <button type=\"submit\">Submit Consent Form<\/button>\r\n<\/form>\r\n<\/main>\r\n\r\n<footer>\r\n Mindcare Treatment Centre | Confidential Clinical Document\r\n<\/footer>\r\n<\/div>\r\n<\/body>\r\n<\/html>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p class=\"tx-excerpt\">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 *","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5615","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages\/5615","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/comments?post=5615"}],"version-history":[{"count":56,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages\/5615\/revisions"}],"predecessor-version":[{"id":5678,"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/pages\/5615\/revisions\/5678"}],"wp:attachment":[{"href":"https:\/\/mindcaretreatmentcentre.com\/bookings\/wp-json\/wp\/v2\/media?parent=5615"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}