Therapy Consent Form

Therapy Consent Form — Form Fields

This healthcare template includes 10 fields. Inform therapy clients about confidentiality, session policies, and their rights before beginning treatment. Free to customize and use on ZenBuild.

• Client Name (text, required)
• Date of Birth (text, required)
• Therapist Name (text, required)
• I understand that therapy sessions are confidential, with exceptions required by law (danger to self/others, child/elder abuse) (multiple choice, required) — options: Yes, I understand
• I understand the cancellation policy (24-hour notice required) (multiple choice, required) — options: Yes, I understand
• I understand that I may end therapy at any time (multiple choice, required) — options: Yes, I understand
• I consent to the use of telehealth sessions when appropriate (multiple choice, required) — options: Yes, No — In-person only
• Questions or Concerns (long text, optional)
• Client Signature (signature, required) — I have read and understand the above information and consent to begin therapy
• Date (text, required)