About this template
A Professional Counselling Informed Consent Form is an essential document utilized by licensed counselors, therapists, mental health clinics, and university counseling centers to formalize the agreement between a client and practitioner before initiating treatment sessions. This form outlines crucial policies including confidentiality terms and its legal exceptions, potential risks and benefits of therapy, cancellation guidelines, and financial terms, while confirming the client's voluntary agreement to participate.
Using Doc2Form, mental health professionals can instantly convert this essential paperwork into a clean, ready-to-use Google Form. This eliminates tedious administrative friction, allowing clients to review terms and provide necessary contact details securely from their smartphones, tablets, or computers before their first appointment. By streamlining intake paperwork, practitioners can dedicate more quality time during initial sessions to building rapport and understanding presenting concerns rather than reviewing paperwork. Furthermore, centralizing responses in Google Drive helps clinics and independent practitioners maintain organized records while upholding professional and ethical intake standards.
Key features
- Streamline client intake with a clear, mobile-friendly consent layout.
- Outline confidentiality terms, practice policies, and treatment risks.
- Collect essential contact details and primary care physician info.
- Instantly convert your existing consent documents into Google Forms with Doc2Form.
Use cases
Private practice mental health therapists onboarding new psychotherap…
Private practice mental health therapists onboarding new psychotherapy clients.
University and school counseling centers registering students for ong…
University and school counseling centers registering students for ongoing support.
Community wellness clinics gathering signed treatment agreements and …
Community wellness clinics gathering signed treatment agreements and contact records.
What this form collects
- Full Legal Name (Short answer)Enter your first and last name.
- Email Address (Short answer)We will use this to send appointment reminders and secure practice updates.
- Phone Number (Short answer)Include area code.
- Home Address (Paragraph)Street address, city, state, and ZIP code.
- Primary Care Physician (GP) Name & Address (Paragraph)Optional: Provide your doctor's contact info in case of medical coordination or emergency referrals.
- Presenting Concerns (Paragraph)Briefly describe what brings you to counseling at this time and your primary goals for therapy.
- Confidentiality & Limits Understanding (Multiple choice)Counseling sessions are strictly confidential, with specific legal exceptions including risk of harm to self or others, and suspected abuse. Do you understand and agree to these terms?
- Client Acknowledgment & Consent to Treatment (Multiple choice)By checking below, you confirm that you have read, understood, and voluntarily agree to participate in counseling services under the stated practice policies.
- Client Signature (Typed Name) (Short answer)Please type your full legal name as an electronic signature to confirm agreement.
- Date Signed (Date)Select today's date.
FAQ
How does using this informed consent form streamline my practice?
It ensures that all essential practice policies, confidentiality terms, and client acknowledgments are gathered systematically before the first session, reducing administrative delays.
Can I customize the questions and policies to match my specific practice guidelines?
Yes, once your form is generated through Doc2Form, you have full control in Google Forms to edit terms, add specific disclaimers, or adjust questions to fit your therapeutic approach.
Is this form mobile-friendly for my clients?
Yes, Google Forms automatically optimize layouts for smartphones and tablets, allowing clients to review and complete the form conveniently from any device.
How do I receive notifications when a client submits their consent form?
You can configure Google Forms to send an instant email notification to your inbox every time a new client submits their completed consent agreement.
Get this form in your Google Drive
Save a copy to your Google Drive with one click (uses 1 credit). Or build from a PDF or description in the app.