Free Therapy Informed Consent Form Template

Ensuring your clients understand therapy processes is crucial for building trust. This template helps therapists clearly outline treatment details and set client expectations. You can enhance your practice with benefits like collecting essential client information, adhering to legal requirements, fostering transparency in the therapy relationship, and facilitating informed decision-making. Explore how this template can simplify your workflow and improve client satisfaction.

When to use this form

Use this consent form before the first session with new individual, couples, or family clients. It is also helpful when you switch to telehealth, add a new modality, or update policies. You capture agreement on services, risks and benefits, privacy limits, fees, cancellations, emergencies, and how you communicate. For remote intake, collect signatures with the Electronic informed consent form. If your setting is brief or low risk (for example, workshops or screenings), start from the Simple informed consent form and add therapy details like limits of confidentiality and crisis contacts. This keeps records clear, reduces disputes, and accelerates onboarding across solo and group practices.

Must Ask Therapy Informed Consent Questions

Do you understand the purpose, potential benefits, risks, and alternatives of therapy, and do you consent to begin?
This confirmation ensures you make an informed choice and reduces misunderstandings later. It sets shared expectations about what therapy can and cannot do.
Do you acknowledge the limits of confidentiality and the situations that require disclosure (for example, risk of harm or abuse)?
Stating these limits upfront builds trust and prevents surprises in crisis situations. It also guides how you choose to share sensitive details.
Do you agree to fees, billing practices, and cancellation or no-show policies, and how will you pay?
Clear financial consent avoids payment disputes and supports steady care. It lets you plan sessions without confusion about costs.
Do you consent to telehealth sessions and understand the technology risks, privacy considerations, and your responsibilities during remote care?
Telehealth consent clarifies how remote care works and what to do if technology fails. It helps you prepare a private space and stable connection for sessions.
How may we use your information beyond treatment (training or de-identified case reports), and what are your data privacy rights?
This captures consent for any secondary use and lets you opt in or out. For publication or teaching, pair this with a Case report consent form; if you are in the EU or serve EU residents, review the GDPR Consent form.

More Forms

Question		Response
Full name		John Smith
Date of birth		2025-10-15T00:00:00.000Z
Primary phone number		555 555 5555
Email address		[email protected]
Are you 18 years of age or older?		Prefer not to say
Emergency contact full name		This is a test
Emergency contact phone number		555 555 5555
Emergency contact relationship to you		This is a test
I understand the purpose and general nature of therapy services has been explained to me.		2
I understand participation in therapy is voluntary and I may pause or end services at any time.		4
I understand potential benefits and risks of therapy, including possible emotional discomfort.		4
I understand services are provided at no cost and may have limits (for example, session caps) and I will be informed if this changes.		3
I understand confidentiality, including its legal limits (for example, safety concerns, abuse/neglect, court orders, or as required by law).		1
I authorize the program to contact me for scheduling and reminders by:		None of the above
If contacting me by phone or text, you may leave:		Not applicable
I acknowledge the risks of electronic communication (for example, email or text may not be fully secure).		2
I consent to receive telehealth services when appropriate.		No
I understand the requirements and potential risks of telehealth (for example, technical issues, privacy in my location).		4
I understand that services may be provided by a clinician-in-training under supervision and that my care may be discussed in supervision using de-identified information.		4
I consent to audio or video recording of sessions for training and supervision purposes.		Yes
If I do not consent to recording, I still consent to receive services without recording.		Not applicable
I received or had the opportunity to review the privacy practices and information on how to raise concerns or complaints.		4
Type your full legal name as your signature		This is a test
Date of consent		2025-10-15T00:00:00.000Z
If the client is under 18: Parent/Guardian full name (type as signature)		This is a test
If the client is under 18: Parent/Guardian date of consent		2025-10-15T00:00:00.000Z
I consent to receive therapy services under the terms described above.		Yes

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Therapy Informed Consent Form Template

Streamline client onboarding with this essential consent template

When to use this form

Must Ask Therapy Informed Consent Questions

More Forms

Unlock hundreds more featuresSave your Form to the DashboardView and Export ResultsUse AI to Create Forms and Analyse Results

Therapy Informed Consent Form Template

Streamline client onboarding with this essential consent template

When to use this form

Must Ask Therapy Informed Consent Questions

More Forms

Unlock hundreds more features
Save your Form to the Dashboard
View and Export Results
Use AI to Create Forms and Analyse Results