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How do I fill this out?
To fill out this form, begin by reading each section carefully. Make sure to initial each page to confirm your understanding. Finally, provide your signature at the end of the document to consent to the therapy.
How to fill out the Informed Consent for Therapy Services?
1
Read each section carefully.
2
Initial each page to confirm understanding.
3
Provide your signature at the end.
4
Ask questions if any section is unclear.
5
Submit the completed form as instructed.
Who needs the Informed Consent for Therapy Services?
1
Individuals seeking therapy services who need consent for treatment.
2
Parents of minors requiring therapy for their children and needing to understand the policies.
3
Clients referred by a court to ensure compliance with therapy requirements.
4
Patients wanting to understand their confidentiality rights before starting therapy.
5
Individuals who have specific conditions requiring detailed informed consent before treatment.
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What are the instructions for submitting this form?
To submit this form, you can email it to our office at info@draylevy.com or fax it to 972-407-1305. Alternatively, you can drop off a physical copy at our office located at 17110 Dallas Parkway Suite 290, Dallas, TX 75248. Please ensure this form is submitted prior to your first therapy session for timely processing.
What are the important dates for this form in 2024 and 2025?
Important dates for this form in 2024 include the start of the new therapy year on January 1st, and annual review sessions throughout the year. In 2025, ensure to re-evaluate consent at the start of the new year and prior to any major therapeutic changes.
What is the purpose of this form?
The purpose of this form is to ensure that clients are fully aware of their rights and the nature of therapy services being offered. It outlines the procedures, privacy rights, and responsibilities of both the therapist and the client. By signing this form, clients indicate their understanding and acceptance of the therapy process.
Tell me about this form and its components and fields line-by-line.
- 1. Personal Information: Name, address, and contact information of the client.
- 2. Understanding of Therapy: Acknowledgment of client's understanding of therapy services.
- 3. Confidentiality Agreement: Agreement to the terms of confidentiality and situations where it may be breached.
- 4. Emergency Contact: Details of a contact person in case of emergencies.
- 5. Signatures: Space for client and therapist signatures to finalize consent.
What happens if I fail to submit this form?
Failing to submit this form may delay the start of your therapy. Without consent, the therapist cannot legally provide services. Addressing confidentiality and emergency protocols without this form can lead to misunderstandings.
- Potential Treatment Delays: Without submission, therapy sessions may be postponed.
- Lack of Legal Protection: The therapist cannot provide services without informed consent.
- Confidentiality Issues: Without signed consent, confidentiality cannot be guaranteed.
How do I know when to use this form?
- 1. New Therapy Intake: Use when starting therapy with a new therapist.
- 2. Court-Ordered Therapy: Necessary for clients referred by legal authorities.
- 3. For Minors: Required signature for consent from guardians of underage clients.
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