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Therapy Informed Consent Form

Get ideas for your therapy informed consent form using this form template. Copy and edit this form in your Jotform account and start publishing it right away. Open the form either by embedding it on your website or launch the form straight to your mobile device. Receive your submissions instantly and manage them through your submissions page. Get this form and the features for free here in Jotform!

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Please read the following information carefully and ask any questions you may have before agreeing to participate in therapy.

Email*

Full Name*

Date of Birth*

Phone Number*

Address*

Emergency Contact Name*

Emergency Contact Phone Number*

Consent to Treatment*

I understand that therapy is not a substitute for medical attention, examination, diagnosis, or treatment.

I understand that the therapist may terminate therapy at any time if they believe it is in my best interest.

I understand that I have the right to refuse any treatment or intervention offered by the therapist.

I understand that the therapist may consult with other professionals regarding my treatment, but my identity will remain confidential.

Consent to Teletherapy

I understand that teletherapy involves the use of electronic communication to provide therapy services.

I understand that there are potential risks and benefits to teletherapy, including but not limited to technical difficulties, interruptions, and breaches of confidentiality.

I understand that I have the right to refuse teletherapy services at any time.

Description:Create a Therapy Informed Consent Form with ease using this template. Customize and publish it on your website or mobile device. Get submissions instantly and manage them through your submissions page. Try it for free on Jotform!

Creating a Therapy Informed Consent Form is now easier than ever with this customizable template. This form is designed to help you get started quickly and efficiently. Simply copy and edit the form in your Jotform account and start publishing it right away. You can embed the form on your website or launch it straight to your mobile device. With Jotform, you can receive your submissions instantly and manage them through your submissions page. This template is completely free to use and comes with a range of features to help you create the perfect Therapy Informed Consent Form for your needs. So why wait? Try it out today and see how Jotform can help streamline your therapy practice!

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Business Phone Number*

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