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Group Therapy Confidentiality Form Template

Ensure privacy and security in your group therapy sessions

In group therapy, maintaining confidentiality can be challenging yet crucial for creating a safe space. This template is designed for therapists and practitioners to clearly outline clients' understanding of privacy terms, ensuring everyone feels secure sharing their thoughts and feelings. With this form, you can establish trust, protect sensitive information, and set clear boundaries, all while meeting compliance standards. Explore how easy it is to customize and implement this essential document in your practice.

Full legal name
Email address (optional)
Phone number (optional)
Group or program name
Date
I will keep the identity and personal information of group members private outside the group.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will not make or share any recordings, images, or screenshots of sessions or group communications.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will join sessions from a private space and use headphones when needed to protect others' privacy.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand confidentiality may be limited if there is risk of serious harm to myself or others.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand confidentiality may be limited in cases of suspected abuse or neglect of a child, elder, or vulnerable adult.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand information may be disclosed if required by law or court order.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
How may we contact you about group-related logistics and materials?
Email
Text
Phone call
No, do not contact me outside sessions
Emergency contact name
Emergency contact phone
I have read and understand the confidentiality commitments and limits described above.
Yes
No
Signature
Signed on
I agree to participate under these terms.
Yes
No
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Paper art illustration depicting a group therapy confidentiality form template for FormCreatorAI

When to use this form

Use this template when you onboard new members to a therapy or support group and need clear, written privacy rules. It helps private practices, clinics, schools, and community groups set ground rules before the first session, during telehealth, or when adding new participants mid-cycle. You can spell out what stays in the room, the limits of confidentiality (risk of harm, abuse, or court orders), and how the facilitator handles breaches. Teams that also run individual sessions can pair it with the Counseling confidentiality form to keep policies consistent. If you combine participation and permission in one packet, add a general Client consent form. The result: participants trust the space, understand their responsibilities, and you reduce misunderstandings and liability.

Must Ask Group Therapy Confidentiality Questions

  1. Do you agree to keep all member identities and shared information confidential outside the group?

    This creates a clear, written commitment so expectations are not left to assumptions. It reduces accidental disclosures and protects trust among participants.

  2. Do you understand the legal and ethical limits of confidentiality, including reporting risks of harm, abuse, or court orders?

    Confirming this shows informed consent and prevents surprises if an exception arises. It helps you act quickly and transparently when safety is at stake.

  3. Will you refrain from recording, screenshots, or sharing chat transcripts from any in-person or virtual session?

    Modern groups span rooms and screens, so this blocks high-risk leaks. It protects privacy even when participants join from home or shared devices.

  4. How should we contact you privately if a confidentiality concern arises, and who may we contact in an emergency?

    Clear contact preferences speed up sensitive outreach without escalating in the group. An emergency contact supports rapid response during safety concerns.

  5. Have you read and agree to the group privacy guidelines and the consequences for breaches?

    This ties agreement to specific rules, not vague promises. It sets fair, consistent follow-up steps if a breach occurs.

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