Informed consent for therapy is the form a client reads, talks through with you, and signs before therapy starts: what therapy involves, its risks, the limits of confidentiality, and the practical terms. Copy the free consent form, see an adult starting video therapy and a 15-year-old starting counseling with a parent, and check what to cover in each part.
Blank informed consent for therapy template
FreeINFORMED CONSENT FOR THERAPY [Practice name] [Address, phone, and email] Client: [Full name] Date of birth: [Date] Therapist: [Name, credentials, and license or registration number] ABOUT YOUR THERAPY Service: [Individual, couples, family, or group therapy] Approach: [The approach your therapist uses, such as CBT, and what it involves, in one or two sentences] Sessions: [Length, how often, and in person or by video] How it works: The first [number] sessions are for getting to know you and your concerns. Then we agree on goals together and review them as we go. You may be asked to practice skills between sessions. BENEFITS, RISKS, AND OTHER OPTIONS Therapy helps many people feel better, cope with problems, and improve their relationships. Results are not guaranteed. Talking about painful things can bring up strong feelings, and you may feel worse for a while before you feel better. Changes you make can affect the people close to you. Other options: [Alternatives such as medication, a support group, a different kind of therapy, or no treatment]. You can ask about them at any time. CONFIDENTIALITY AND ITS LIMITS What you say in therapy is private. Your therapist will not share it without your written consent, except in the situations below, when the law requires or allows it: - A serious risk that you will harm yourself or someone else - Suspected abuse or neglect of a child or a vulnerable adult - A court order - [Any other exceptions that apply where you practice] When it is safe to do so, your therapist will talk with you before sharing anything. Consultation: [Whether your therapist discusses their work with a supervisor or colleague, without your name] RECORDS AND RECORDING Your therapist keeps a record of each session. It is stored [how and where] and kept for [number] years after your last session. To see your record or get a copy: [How to ask, and how long it takes] Recording: [Whether sessions are recorded or an AI scribe drafts the notes, what is kept, and for how long] I agree to recording or an AI scribe: [Yes or no] FEES AND CANCELLATIONS Fee: [Amount per session, and the session length] Payment: [When and how to pay, and any insurance or benefits billing] Cancellations: [Notice needed, and the fee for a late cancellation or a missed session] Other fees: [Letters, reports, or other work outside sessions] CONTACTING YOUR THERAPIST How to reach your therapist: [Phone, email, or client portal] Replies: [Usual reply time, such as within one business day] Messages are for scheduling and practical questions. They are not checked outside office hours. THERAPY BY VIDEO OR PHONE Platform: [The video platform used] At the start of each session, your therapist will confirm where you are. Join from a private place where you can't be overheard. Your therapist can see you only while you are somewhere they are allowed to practice. Tell them before a session if you will be away. If the call drops: [The backup plan, such as your therapist calls you back at the number on file] Emergency contact: [Name and phone of someone your therapist can call if they believe you are in danger] IN AN EMERGENCY Your therapist is not available around the clock. If you are in crisis, call or text 988. If you or someone else is in immediate danger, call 911 or go to the nearest emergency department. CLIENTS UNDER [AGE] Who can consent: [Who can consent to therapy for a young person where you practice] What a parent or guardian will be told: [Such as attendance, general progress, and goals] What stays between the young person and the therapist: [What they say in sessions, unless there is a serious safety risk] If there is a serious risk to the young person's safety, your therapist will tell a parent or guardian, and will talk with the young person first when it is safe to do so. YOUR RIGHTS You can ask questions about your therapy at any time. You can refuse any part of it, withdraw your consent, or end therapy at any time. Your therapist can suggest other services if you'd like. Your therapist may suggest ending therapy if it is not helping, and will talk with you about other options. If you have a concern, please raise it with your therapist first. You can also contact your therapist's regulator: [Name of the licensing or registration body, and its contact details] CONSENT I have read this form, or had it read to me, and my questions have been answered. I agree to start therapy with [Therapist name]. Client: [Name, signature, and date] Parent or guardian: [Name, relationship, signature, and date, if needed] Therapist: [Name, signature, and date]
Use it for
Each one follows the template. Use them to judge how much detail every part needs.
Private practice, individual therapy by video, reviewed at the start of the first session
Service: individual therapy for Marcus Bell, 34, with Dana Okafor, counselor. Approach: cognitive behavioral therapy for panic attacks: learning how panic works, spotting the thoughts that feed it, and facing the body sensations and places he avoids, step by step. Sessions: 50 minutes, weekly, by video. The first 2 sessions are an assessment; goals are then agreed and reviewed every 6 sessions.
Many people with panic attacks improve with CBT; results are not guaranteed. Facing feared sensations on purpose can raise anxiety for a while before it eases. Other options discussed: medication through his family physician, a group program, or waiting. He chose therapy on its own for now.
Exceptions explained: serious risk of harm to himself or others, suspected abuse or neglect of a child or vulnerable adult, and court orders. Dana discusses cases with a peer consultation group once a month, without names. Records are kept in an encrypted electronic record for 10 years after the last session; he can ask for a copy through the client portal. AI scribe: drafts each session note, and the audio is deleted once the note is finished. He agreed, and can ask to turn it off at any time.
$160 per 50-minute session, charged to the card on file after each session; receipts for his benefits plan are in the portal. Cancellations need 24 hours’ notice; a late cancellation or missed session costs the full fee. Portal messages are answered within 1 business day and are not checked on weekends.
Joins from his apartment, alone, with headphones; Dana confirms his location at the start of each session. Sessions only while he is somewhere Dana is allowed to practice; he will tell her before any work trip. If the call drops, Dana calls his mobile. Emergency contact: his sister, Leah Bell, number on file. In a crisis: call or text 988, or call 911 or go to the nearest emergency department.
Form sent through the portal 3 days ahead and reviewed together for 10 minutes at the start of the first session on November 3, 2026. He asked whether his employer would find out he’s in therapy. Explained that nothing is shared without his written consent outside the exceptions, and that benefits receipts show the date, service, and fee, not what was discussed. Asked him to say the exceptions in his own words; he named all three. Agreed to the AI scribe. Signed electronically; copy saved to his portal.
Group counseling practice, first session in person, with the client and her mother
Service: individual counseling for Maya Chen, 15, with Sam Rivera, counselor. Referred by her school counselor for anxiety and missed school days since the family moved in the summer. Approach: CBT for anxiety, with practice between sessions and a step-by-step plan back to full school days. Sessions: 50 minutes, weekly, in person, for about 12 weeks. Maya is seen alone; her mother joins for the last 10 minutes when Maya agrees.
Under the rules where the practice is, a parent’s consent is needed at Maya’s age. Her mother, Lin Chen, signed as parent. Maya signed too, to show she agrees to counseling. Her parents share custody; her father agreed by phone on November 4 and was sent a copy of the form.
Stays between Maya and Sam: what she says in sessions, including about friends, relationships, and alcohol or drug use, unless it puts her in serious danger. Her mother will be told: attendance, the goals Maya agrees to share, and a general update once a month, with Maya there when possible. Sam will tell her parents without Maya’s agreement only for a serious risk to her safety or someone else’s, such as a plan to end her life or self-harm that needs medical care; Sam will tell Maya first when it is safe and invite her to take part in that conversation. Suspected abuse or neglect is reported to child protection services as the law requires, and is not always shared with her parents.
Records are kept for as long as the rules where the practice is require. A parent’s request to see the record follows those rules, and Sam will talk with Maya before anything is released. $140 per session, paid by her mother at each visit; her insurance plan pays back part of it. No recording or AI scribe is used. Her mother can call Sam about scheduling and other practical questions; Sam will tell Maya about any call and won’t share what Maya said in sessions.
Sam is not available after hours. Maya and her mother both have the crisis steps: call or text 988, or call 911 or go to the nearest emergency department. During the school day, Maya can also go to her school counselor.
Went through the form with Maya and her mother together for 20 minutes, then with Maya alone for 5 minutes so she could ask questions privately. Maya asked whether her mother would hear if she said she’d been drinking at a party. Explained that it would stay private unless it put her in serious danger, and that Sam might encourage her to tell her mother herself. Her mother asked for a summary after every session; they agreed instead on a monthly update with Maya present. Maya explained back, in her own words, when Sam would tell her parents. Both signed; copies given to each.
What the client is agreeing to: the service, your approach, and how sessions will run.
Avoid: Naming an approach without saying what it involves. “CBT” means little to most clients; “we’ll look at how thoughts affect feelings, and practice skills between sessions” does.
An honest account of what therapy can and can’t do, so the client’s choice is informed.
Avoid: Listing only benefits. Consent is informed only when the client also hears the risks and the other options.
When you may share information without the client’s consent, in words they will understand.
Avoid: Promising that “everything stays in this room.” Name the exceptions, and say you’ll talk with the client first when it’s safe to.
What you keep, for how long, how the client can see it, and whether anything is recorded.
Avoid: Folding recording into the main signature. Ask on its own line, so the client can agree to therapy and still say no to recording.
The practical terms that most often cause disagreements later.
Avoid: Charging a missed-session fee the client never agreed to. Put the amount in writing before the first session.
How video or phone sessions stay private and safe, and what the client should do in a crisis.
Avoid: Starting a video session without knowing where the client is. If a crisis happens, you need an address to send help to.
Who can consent for a young person, and what a parent or guardian will and won’t be told.
Avoid: Settling the parent’s role after a problem comes up. Agree on it with both of them at the first session, in writing.
The client’s rights, how to raise a concern, and a record of who agreed.
Avoid: A signature collected in the waiting room with no discussion. Go through the form together and note the client’s questions.
Consent is the conversation; the signature records it. Go through the main points aloud, check the client understood, and note their questions in your record.
Exceptions to confidentiality, how long records are kept, and who can consent for a young person differ by place and profession. Check each against the rules where you practice and your regulator’s guidance.
Revisit consent when something changes: a new approach, a family member joining, starting recording, moving to video, or a young client reaching the age where they can consent alone.
Long sentences and legal terms bury the main points. Use plain words, offer the form in the client’s language where you can, and read it aloud if needed.
Vero Scribe drafts the consent record in your template from the first session, with the client’s consent, or from your dictation: what you explained, what the client asked, and what they agreed to. You review and edit every section, then copy it into your record or export it to Word or PDF. Vero works in 60+ languages.
The service and your approach, what therapy involves, its benefits and risks, other options, the limits of confidentiality, records, fees and cancellations, how to reach you, video sessions, what to do in an emergency, consent to recording or an AI scribe, and the client’s right to ask questions, withdraw, or end therapy. Add a section on parents and guardians if you see young people.
This form is what the client reads and signs. The consent section of your intake assessment is your record that you went through it: what you explained, what the client asked, and that they understood. Use both.
The age at which a young person can consent to therapy alone differs from place to place, and sometimes depends on their understanding rather than a set age. Follow your local rules on who can consent. When a parent or guardian consents, get the young person’s agreement too, and write down what the parent will and won’t be told.
The platform you use; that you confirm the client’s location at each session; that they join from a private place; that you see them only while they are somewhere you are allowed to practice; a backup plan if the call drops; and an emergency contact you can call.
Yes. Copy it, or download it as a Word or text file. No account needed.
One psychotherapy session: focus, interventions, client response, risk, and progress toward goals.
A CBT session in its own order: mood check, agenda, homework review, thought or exposure work, new homework, and feedback.
An EMDR session by phase: target, negative and positive cognitions, SUD and VOC, bilateral sets, closure, and reevaluation.
Data, Assessment, Plan: the three-part session note, with the line between facts and judgment made clear.
Goal, Intervention, Response, Plan: a progress note that opens with the treatment plan goal.
Intake, consent, and progress notes, drafted from the session for your review.
Shared templates and onboarding for every therapist on your team.
Session notes, client resources, and follow-up in one place.
The codes used most often in therapy and counseling.
Vero writes your notes and letters in the templates you choose, so you review instead of type.
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