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Consent Form Assessment and Treatment

This informed consent form outlines the process and expectations for psychological consultation and treatment at the School of Criminology and Behavioural Sciences. It states that an initial assessment will determine the appropriate course of treatment. The psychotherapist has discretion over recommendations but is not responsible for adverse events. Consultations are confidential except if mandated by law. Some professionals may be in training but supervised. Psychological therapies could provide benefits but also elicit uncomfortable thoughts and feelings. The client may discontinue treatment at any time. The client provides consent by signing and providing contact information.

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Saroja Roy
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329 views1 page

Consent Form Assessment and Treatment

This informed consent form outlines the process and expectations for psychological consultation and treatment at the School of Criminology and Behavioural Sciences. It states that an initial assessment will determine the appropriate course of treatment. The psychotherapist has discretion over recommendations but is not responsible for adverse events. Consultations are confidential except if mandated by law. Some professionals may be in training but supervised. Psychological therapies could provide benefits but also elicit uncomfortable thoughts and feelings. The client may discontinue treatment at any time. The client provides consent by signing and providing contact information.

Uploaded by

Saroja Roy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INFORMED CONSENT FORM

Informed consent for consultation with Clinical Psychologists for Mental health issues and psychological wellbeing
at School of Criminology and Behavioural Sciences (SCBS), Rashtriya Raksha University.

Name: _______________________________ Reg.No:


I understand that the type and extent of psychological intervention, which includes psychological
assessment and treatment that I will receive at the School of Criminology and Behavioural Sciences
will be determined following an initial clinical /rehabilitation assessment of my problem/s through
an interview with me, and/or my family members. The goal of this assessment process is to
determine the best course of treatment for me.
I understand that the psychotherapist would use their professional discretion to provide required
recommendations about the type of professional service that may be required at any given point of
time. At the same time, I agree to not hold my psychotherapist responsible, should any adverse
events, such as lack of improvement, deterioration, or situations of the potential risk of harm to self
or others, occur during video/ audio consultation. I understand that in such situations I may be
advised to obtain treatment at the nearest available mental health or emergency service.

I understand that this consultation is strictly confidential. I understand that my psychotherapist will
not audio or video record the session and will not share the proceedings of this consultation with
any other individual or agency. However, with my consent, my psychotherapist could use it to have
their work supervised or for the training of professionals. Apart from this, the details of the
consultation would be shared only with a court of law, if mandated.
I understand that some of the professionals involved in my assessment or treatment may be under
training and in such cases, all professionals-in-training are supervised by qualified and licensed
staff.
Typically, psychological treatment is provided over the course of several weeks. I understand that
while psychological therapies may provide significant benefits, they may also pose risks.
Psychological therapies may elicit uncomfortable thoughts and feelings, or may lead to the recall
of troubling memories. I also understand that I can discontinue or refuse the therapy and therapist
anytime I wish.
Consent: I hereby provide my informed consent for consultations for psychotherapy at School of
Criminology and Behavioural Sciences (SCBS), Rashtriya Raksha University.
My current residential address and phone number:

The contents of this form have been explained to me in a language that I understand.
After reading/listening to and understanding all of the above, I am giving my consent for:

Name & Signature: Date:

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