About this template
A Therapy Informed Consent Form is an essential document used by mental health professionals, counselors, and therapists to establish a transparent, ethical foundation with new clients before treatment begins. This form outlines the therapeutic process, confidentiality limits, session policies, cancellation terms, and client rights, ensuring that patients fully understand what to expect from their sessions.
Establishing clear communication and mutual trust from the very first interaction is vital for successful therapeutic outcomes. This digital template allows practitioners to seamlessly collect client acknowledgments, emergency contact details, and electronic signatures prior to the initial appointment. By streamlining this onboarding step, clinics and independent practices can reduce administrative friction, ensure compliance with clinical standards, and maintain organized digital records for every client.
Doc2Form makes it easy to transform this critical document into a customized Google Form in seconds. Practitioners can easily adapt the template to include specific practice policies, telehealth guidelines, and fee structures, providing a professional and frictionless experience for incoming clients.
Key features
- Collect client acknowledgments and electronic signatures securely
- Outline confidentiality policies, cancellation terms, and fees clearly
- Gather emergency contact and background information before session one
- Easily customize practice policies and telehealth guidelines
- Organize client submissions directly in your connected Google Drive
Use cases
- Private practice intake for new psychotherapy clients
- Initial consultations at outpatient mental health clinics
- Telehealth counseling onboarding and remote consent collection
- Student counseling centers establishing initial treatment agreements
What this form collects
- Client Full Name (Short answer)Enter your first and last name.
- Date of Birth (Date)Enter your date of birth (MM/DD/YYYY).
- Email Address (Short answer)Enter the email address where we can reach you regarding scheduling and appointments.
- Phone Number (Short answer)Enter your primary contact number.
- Are you 18 years of age or older? (Multiple choice)If you are under 18, a parent or legal guardian signature will also be required.
- Legal Guardian Name (if client is a minor) (Short answer)Enter the full name of the parent or legal guardian filling out this form on behalf of a minor.
- Emergency Contact Name and Relationship (Short answer)Provide the name and relationship of someone we can contact in case of an emergency.
- Emergency Contact Phone Number (Short answer)Enter the phone number for your emergency contact.
- Acknowledgment of Practice Policies (Multiple choice)Please confirm that you have read and agree to our policies regarding confidentiality, session fees, and our 24-hour cancellation policy.
- Client Acknowledgment & Consent (Short answer)By typing your full name below, you confirm that you are voluntarily seeking therapy services and consent to treatment.
- Today's Date (Date)Select today's date.
FAQ
What is a therapy informed consent form?
It is a document that explains the nature of therapy, potential risks and benefits, confidentiality limits, and office policies, allowing clients to give educated permission to begin treatment.
Why is informed consent important in therapy?
It protects client autonomy and builds trust by ensuring patients understand their rights, responsibilities, and the structure of the therapeutic relationship from the start.
Can clients withdraw their consent after signing?
Yes, clients generally retain the right to discontinue therapy at any time, and your form can include a brief statement clarifying this policy.
How can I customize this template for my practice?
With Doc2Form, you can instantly convert this template into a Google Form, allowing you to edit policies, add your practice name, and adjust questions to match your specific clinical approach.
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.