Informed Consent for Psychotherapy - General Information

This consent is being executed in conjunction with the use of the Platform, the Terms of Service and Terms of Use. This Consent is being signed for the benefit of the Professional providing Psychotherapy and the consenting individual (“client”).

This consent provides a clear framework for the work between the Professional and the client. Feel free to discuss any of this with the Professional. Please read and indicate that you have reviewed this information and agree to it by filling in the checkbox at the end of this document.

Confidentiality: The session content and all relevant materials to the client’s treatment will be held confidential unless the client requests in writing to have all or portions of such content released to a specifically named person/persons. Limitations of such client held privilege of confidentiality exist and are itemized below:

1. If a client threatens or attempts to commit suicide or otherwise conducts themselves in a manner in which there is a substantial risk of incurring serious bodily harm.

2. If a client threatens grave bodily harm or death to another person.

3. If the therapist has a reasonable suspicion that a client or other named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.

4. Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.

5. Suspected neglect of the parties named in items #3 and # 4.

6. If a court of law issues a legitimate subpoena for information stated on the subpoena.

7. If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.

Occasionally, the Professional may need to consult with other professionals in their areas of expertise in order to provide the best treatment for the client. Client’s Information may be shared in this context without using your name. If the client and the Professional see each other accidentally outside of the therapy office, the Professional will not acknowledge the client to maintain client’s privacy and confidentiality. However, as a client, you may acknowledge the professional, however will avoid discussing any on-going sessions.

I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

Client