Counselling Consent Form

Counselling Consent Form is a document signed by the client and his/her counsellor which gives the counsellor the permission to provide counselling services to the client. This document also outlines the terms and conditions of the counselling relationship and the limits of confidentiality.

Time to complete

2 minutes

Eligibility

Anybody above 18 years of age who is looking forward to attending a counselling session can fill this form

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Questions for Counselling Consent Form

1.

Name

The answer should be a text input.
2.

Email Address

The answer should be an email input.
3.

Contact number

The answer should be a text input.
4.

Name of the Counsellor

The answer should be a single choice:
    5.

    I understand that there are some limits to confidentiality and these include: 1. If there is a reasonable suspicion of child abuse 2. If there is a reasonable suspicion of serious elder abuse 3. If there is a reasonable suspicion of serious bodily harm to myself or someone else 4. If I disclose an intention to commit a serious crime 5. If the counsellor is ordered by a court of law to release information 6. If the counsellor’s notes are subpoenaed by a court of law 6. If the counsellor’s notes are subpoenaed by a court of law 7. If the counsellor is required to release information to a professional regulatory body

    The answer should be a single choice:
    1. Yes
    2. No
    6.

    I understand that the counselling process is confidential and that information will not be shared with anyone without my written consent

    The answer should be a single choice:
    1. Yes
    2. No
    7.

    I understand that the counselling process is voluntary and that I may withdraw my consent at any time.

    The answer should be a single choice:
    1. Yes
    2. No
    8.

    I understand that I am responsible for my own wellbeing and that of my family and that I may need to seek additional support outside of counselling if I feel that my wellbeing is at risk.

    The answer should be a single choice:
    1. Yes
    2. No
    9.

    Signature

    The answer should be a signature.
    10.

    Date

    The answer should be a date input.

    Similar Ideas

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    • Privacy Policy

    Here are some FAQs and additional information
    on
    Counselling Consent Form

    What is counselling?

    Counselling is a process whereby a trained counsellor helps an individual to explore their thoughts, feelings and behaviours in order to bring about positive change.

    What is the counselling consent form?

    The counselling consent form is a document that outlines the terms and conditions of counselling services. It is important to read and understand the form before signing it.

    What are the terms and conditions of counselling services?

    The terms and conditions of counselling services vary from counsellor to counsellor. It is important to read and understand the form before signing it.

    Do I have to sign the form?

    You are not required to sign the form, but it is recommended. By signing the form, you are indicating that you understand and agree to the terms and conditions of counselling services.

    What if I don't want to sign the counselling consent form?

    If you do not want to sign the form, you can still receive counselling services. However, your counsellor may not be able to provide you with the full range of services if you do not sign the form.

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