The Therapy Consent Form Template UK is offered in multiple formats including PDF, Word, and Google Docs, featuring editable and printable examples.
Therapy Consent Form Template UK Editable – PrintableSample
Therapy Consent Form Template UK 1. Client Information 2. Contact Information 3. Emergency Contact Information 4. Therapist Information 5. Therapy Details 6. Purpose of Therapy 7. Risks and Benefits 8. Confidentiality and Limits 9. Treatment Costs and Payment Policy 10. Cancellation Policy 11. Consent and Agreement 12. Declaration and Signatures
PDF
WORD
Examples
[Client’s Full Name]
[Client’s Date of Birth]
[Client’s Address]
[Client’s Phone Number]
[Client’s Email Address]
[Therapist’s Name]
[Therapist’s Qualifications]
[Therapist’s Address]
[Therapist’s Phone Number]
[Therapist’s Email Address]
This consent form outlines the nature, purpose, and potential risks of therapy sessions conducted by [Therapist’s Name]. By signing this document, you acknowledge that you understand the information provided and consent to participate in therapy.
The sessions aim to assist clients in improving psychological well-being, coping with stress, addressing mental health issues, and achieving personal goals.
All information discussed during therapy is confidential, except in situations where there is a risk of harm to yourself or others, or if required by law.
You have the right to ask questions about the therapy process, to withdraw your consent at any time, and to request a copy of your records.
Therapy can evoke strong emotions and may sometimes lead to uncomfortable feelings and challenges. It is important to discuss any concerns with your therapist throughout the process.
I acknowledge that I have read and understood the above information regarding therapy and hereby consent to receive therapeutic services from [Therapist’s Name].
[Signature of the Client]
[Full Name of the Client]
[Signature of the Therapist]
[Full Name of the Therapist]
[Client’s Full Name]
[Client’s Date of Birth]
[Client’s Address]
[Client’s Phone Number]
[Client’s Email Address]
[Therapist’s Name]
[Therapist’s Qualifications]
[Therapist’s Registration Number]
[Therapist’s Professional Body]
This consent form informs you about the therapy process, its aims, and the responsibilities of both client and therapist throughout the treatment.
Therapeutic sessions may involve discussions about feelings, thoughts, and behaviors. The frequency and duration of sessions will be determined based on the client’s needs.
All information will be kept confidential. Exceptions to this include circumstances of risk, harm, or legal obligations as determined by the therapist.
You are encouraged to actively participate in your therapy. Your feedback is vital to your treatment plan.
Therapy may sometimes bring up distressing thoughts or emotions. It’s important to communicate with your therapist about your experiences during sessions.
I confirm that I have been informed about the nature of therapy and the confidentiality policy. I consent to receive therapy from [Therapist’s Name].
[Signature of the Client]
[Full Name of the Client]
[Signature of the Therapist]
[Full Name of the Therapist]
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