Therapy Consent Form
The Therapy Consent Form is a document that is used by a therapist to obtain consent from a patient for treatment. The form usually includes all relevant information about the treatment, including the risks and benefits. It should also explain the patient's rights and responsibilities.
2 minutes to complete
Eligibility
The therapy consent form should be filled out and signed by the patient or by the parent/guardian in case the patient is below 18 years of age and is seeking therapy treatment. The consent form should be filled out by a patient who has been diagnosed with a mental condition by a qualified healthcare professional. The consent form should be filled out by a patient who is seeking therapy.
Questions for Therapy Consent Form
Questions
1.
Patient Name
The answer should be a text input.
2.
Patient Address
The answer should be a text input.
3.
Patient Phone Number
The answer should be a phone number.
4.
Patient Email
The answer should be an email input.
5.
Date of Birth
The answer should be a date input.
6.
Therapist Name
The answer should be a text input.
7.
Please select the items that you believe is affecting you.
The answer should be a multiple choice:
- Alcohol/Drugs
- Anxiety
- Stress
- Relationship
- Sadness/Depression
- Sleep disorder
- Procastination
- Traumatic experiences
8.
I hereby give my consent to participate in the therapy session with my therapist.
The answer should be a single choice:
- I Agree
- I Disagree
9.
Signature
The answer should be a signature.
10.
Date
The answer should be a date input.
Forms Similar to Therapy Consent Form
- Psychotherapy Consent Form
- Informed Consent for Psychotherapy
- Consent to Treatment
- Psychotherapy Patient Bill of Rights
- Therapy Consent Form for Minors
- Couples Therapy Consent Form
Here are some FAQs and additional information
on Therapy Consent Form
What is therapy?
Therapy is a process of working to improve your mental and emotional well-being. It can help you to understand and work through difficult experiences, develop new skills and perspectives, and make positive changes in your life.
What can I expect from therapy?
The focus and format of therapy will be based on your needs and goals. In general, therapy involves meeting with a therapist on a regular basis (usually once a week) to talk about your thoughts, feelings, and experiences. The therapist will provide guidance and support as you work to improve your well-being.
What is the purpose of the therapy consent form?
Purpose of a therapy consent form is to inform clients, patients, or subjects of what information you're obtaining, what rights they're waiving, and other pertinent details
Want to use this template?
Loved by people at home
and at work
“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
What's next? Try out templates like
Therapy Consent Form
1000+ Templates, 50+ Categories
Want to create secure online forms and surveys?
Join BlockSurvey.
Welcome to BlockSurvey
Finally, build secure surveys. It only takes seconds to sign up.