The Center For Ethical Practice | Sample Handouts & Patient Consent Forms

Practice Resources

Sample Handouts & Patient Consent Forms

Sample Handouts & Patient Consent Forms

NOTE: Clinicians must “personalize” some of these forms to reflect policies in their own settings

Adolescent Informed Consent Form

Agreement for Confidentiality of Individual Treatment

Confidentiality Contract for Marital or Couple Therapy

Couple Informed Consent Form

Custody Agreements

Informed Consent For Clinical Consultation (Consultant-Consultee Contract)

Informed Consent for Therapy Services – Adult

Informed Consent Form: Child Therapy: Separated/Divorced Parents

Notice of Child Counseling – For Separated Parent

Notice of Privacy Policies –
Sample Client Handout About Limits of Confidentiality

POTENTIAL LIMITS OF CONFIDENTIALITY:
OUTLINE & HANDOUT

Sample Non-Subpoena Contract for Clients in
Couple, Family, or Child/Parent Therapy

Sample Notice of Privacy Practices
With Links to Relevant Virginia Laws

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