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.
Patient Phone Number
Date of Birth
Please select the items that you believe is affecting you.
I hereby give my consent to participate in the therapy session with my therapist.