Consent To Treatment Form for Evaluation and Therapy

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Consent Form for Evaluation and Therapy

In order to provide quality assessment and therapeutic services, our therapists will collect and record personal information relevant to your situation.

Purpose of collecting and holding information

Any personal information gathered as part of your assessment and treatment process will be kept securely and, in the interests of your privacy, used only by our Therapists and the authorized personnel (as necessary). Your personal information is retained in order to document what happens during sessions, and assist our therapists in providing relevant and informed services to your child.

Access to client information

You are entitled to access your personal information kept on file, unless relevant legislation states otherwise. If you require access to your information please discuss this with your therapist.

Disclosure of personal information

Personal information gathered during intake and/or by your Therapist during the provision of services is considered confidential and will not be disclosed to another party except with:

- your prior approval has been obtained to:

a) provide a written report to another professional or agency. eg. a Doctor or a Lawyer; or

b) discuss your care with another person, eg. a Parent, Employer or Health Care Provider; or

- it is subpoenaed by a court

Internships/Training: Metamorphosis Therapy accepts student therapists/analysts in training that may be involved in your child’s assessment/treatment process.

Confirmation of Consent

I have read and understood this Consent Form, and I agree to the above conditions for the services. I hereby authorize assessment and treatment as deemed medically necessary. I will be provided with a copy of my child’s plan(s) of care and able to ask questions about my child’s treatment plan at any time throughout the treatment plan.

Your information will be encrypted.