Youth Consent Forms

Youth Consent Forms

Please complete all three forms

This form provides a variety of information needed at the first appointment.  Demographic information includes you and your child’s legal names, address, phone numbers, and school information.  We also request information about medication, developmental concerns, past providers, and interests to help us better understand you.  Finally, there is a symptoms checklist that helps the therapist to understand your reasons for seeking assistance.  Please print this, complete it, and bring it to your initial appointment.

In order for a child, especially an adolescent, to feel safe enough to benefit from psychotherapy, they need to know that what they share is protected.  Often families end up in legal proceedings such as divorce and youth are reluctant to share their concerns because of fear that the therapist could end up in court sharing what was said or their parents could request such information to use against the other parent or against the youth.  This form ensures that both parents agree that they will not review the youth’s medical record and will not subpoena the therapist or the record should a matter involving their child end up in court.  Please print it, review it, and if no questions sign it.  We also review this document at the first appointment and answer any questions you might have.

Informed consent stems from the from the mental health provider's ethical duty to ensure that the client or their legal guardian is involved in decisions about his or her own treatment. The process of ensuring informed consent involves information exchanged between therapist and client and is a part of patient education. In words the client can understand, the therapist conveys the details of a treatment or procedure, its potential benefits and serious risks, and any feasible alternatives. The attached document covers this requirement. Please print it, review it, and if no questions sign it. At the first appointment we review informed consent and any questions are answered.