Counseling informed consent template
A counseling informed consent document is the first thing a new client signs, and one of the most important. It explains what therapy involves, what it costs, and exactly when you'd have to break confidentiality, so the client can make a real choice before they share anything. Read this template below, then open it in SignMaster and send it with the intake paperwork.
Updated November 5, 2026 · 3 min read
The contract
Gray blanks are yours to fill in before you send. Each signer fills in the blanks in their color.
- You, before sending
- Client
- Counselor
Counseling Informed Consent
This document is an agreement between Client name (the "Client") and Counselor name and credentials of Practice name (the "Counselor"). It explains how counseling works here, so the Client can decide whether to begin. Please ask about anything that isn't clear.
1. About counseling
Counseling is a working relationship in which the Client and the Counselor talk through concerns, set goals and try new ways of coping. Many people find it helps with stress, mood, relationships and decisions. It can also bring up painful feelings or memories, and changes the Client makes may affect people close to them. Progress takes time and active effort, and no particular outcome can be promised.
2. The Counselor
The Counselor holds a License type and number issued by the state of State of license. Their approach includes Therapy approaches. The Counselor may consult with a supervisor or colleagues about the Client's care without sharing the Client's name.
3. Sessions
Sessions last about Session length in minutes minutes and usually happen Usual session frequency. Sessions held by video or phone are covered by a separate telehealth consent.
4. Fees and insurance
- First session: First session fee. Later sessions: Session fee.
- Payment is due at each session, unless another arrangement is agreed in writing.
- If the Client uses insurance, the insurer will receive the information it needs to pay, which usually includes a diagnosis, and the Client pays any amount it doesn't.
- If the Client isn't using insurance, they have the right to a Good Faith Estimate of expected charges.
5. Missed sessions
Sessions canceled with less than Cancellation notice in hours hours' notice, or missed, are charged Missed session fee. Insurance does not pay for missed sessions. The Counselor will waive the fee for genuine emergencies.
6. Confidentiality and its limits
What the Client shares in counseling stays confidential, and the Counselor will not share it without the Client's written permission, except in these situations:
- The Counselor believes the Client is at serious risk of harming themselves, or someone else is at serious risk of harm from the Client.
- The Counselor suspects abuse or neglect of a child, an elderly person or a dependent adult, which the law requires them to report.
- A court orders the release of records, or the law otherwise requires disclosure.
- Insurance billing, as described in section 4, and anonymous consultation, as in section 2.
When the Client is a minor, state law decides what parents or guardians may see. The Counselor will explain how this works before counseling begins.
7. Contact between sessions and emergencies
The Client may reach the Counselor by Contact methods for scheduling and brief matters, and will usually hear back within Reply time in hours business hours. Email and text messages are not fully secure. The Counselor is not available for emergencies: in a crisis, call or text 988 (the Suicide and Crisis Lifeline), call 911, or go to the nearest emergency room.
8. Records
The Counselor keeps brief records of each session, stores them securely, and keeps them for as long as state law requires. The Client may ask to see or receive a copy of their records.
9. Boundaries outside sessions
To protect the Client's privacy, the Counselor does not connect with clients on social media. If the two meet in public, the Counselor will not greet the Client unless the Client speaks first. The Counselor won't enter a business, social or other relationship with a client outside counseling.
10. Ending counseling
The Client may end counseling at any time. The Counselor may suggest ending or a referral if counseling isn't helping or the Client needs a different kind of care. If there has been no session or contact for Days before file is closed days, the Counselor will treat counseling as ended and let the Client know they're welcome back.
Client contact details
Phone: Client phone Email: Client email Emergency contact: Emergency contact
May the Counselor leave messages by voicemail or text at this number? Yes, messages are fine.
I have read this document, including the limits of confidentiality in section 6, my questions have been answered, and I agree to begin counseling.
Client (or parent or guardian of a minor)
Counselor
Opens it in SignMaster as a template you can edit and send.
A starting point, not legal advice. Have a lawyer review it for your state and situation.
On this page
What informed consent means in counseling
Professional ethics codes ask counselors and psychologists to tell clients, as early as possible, about the nature of therapy, fees, the involvement of third parties and the limits of confidentiality. The APA Ethics Code, for example, covers informed consent to therapy in standard 10.01, and the ACA Code of Ethics has its own section on it. A signed document doesn't replace talking it through in the first session, but it gives the client time to read it at home and gives you a record.
Clients most often misunderstand the confidentiality limits. Spelling them out, in plain language, before the first session prevents the worst kind of surprise later.
What the template covers
- About counseling: the benefits, the discomfort it can bring, and no promised outcome.
- The counselor: license type, number and state, approach, and anonymous consultation.
- Sessions and fees: length, frequency, rates, insurance and the right to a Good Faith Estimate for clients paying themselves.
- Missed sessions, with a fee you can waive for real emergencies.
- Confidentiality and its limits: risk of harm, mandated abuse reporting, court orders and billing, plus a note on minors.
- Contact and emergencies: how to reach you, reply times, unsecured email and text, and 988 and 911 for a crisis.
- Records, boundaries outside sessions and ending counseling, including when an inactive file closes.
- Message permission: a tick box for voicemail and texts.
Mistakes to avoid
- Burying the confidentiality limits on page four. Put them in their own section and go over them aloud in the first session.
- Forgetting self-pay clients' rights. Under the federal No Surprises Act, providers usually must give clients who aren't using insurance a Good Faith Estimate of expected charges.
- Promising to answer texts at any hour. Say how you can be reached, how fast you reply, and where to go in a crisis.
- Assuming one form fits minors. Parents' access to a teenager's records depends on state law, so explain your state's rules to the family at the first session.
Privacy rules for therapists
If your practice is a HIPAA covered entity, you also owe clients a Notice of Privacy Practices. SignMaster doesn't claim HIPAA compliance, so talk to your compliance adviser before sending clinical information through it; this consent form itself holds contact details and agreements, not session notes.
How to send it with SignMaster
- 1
Open the template
Choose Use this template. The client signs first and you sign second.
- 2
Add your practice details
Fill in the gray blanks: your name and credentials, license, approach, fees, cancellation window, contact methods and when inactive files close. To change a sentence, cover it with White-out from the editor's Markup tools and type your own in a Text box.
- 3
Send it before the first session
Enter the client's name and email and set a sign-by date a day or two before you meet. They fill in the blue blanks, contact details, emergency contact and whether messages are fine, and sign privately at home.
- 4
Protect it with an access code
Add an access code the client must enter before the document opens: one you give them at the consultation call, or a one-time code SignMaster emails them.
- 5
Countersign after the first session
Once you've talked it through together, sign as the counselor. Both of you get the signed PDF and its certificate of completion.
Telehealth clients
If you see clients by video, pair this form with a telehealth consent form in the same envelope. Roles with the same name merge, so the client signs both documents in one sitting, and you countersign both at once.
Questions? Answers.
What should a counseling informed consent include?
At minimum: what counseling involves, its benefits and risks, fees and cancellation terms, the limits of confidentiality, how to reach you and what to do in an emergency, how records are kept, and how counseling ends.
Do I need consent from both parents for a minor?
It depends on your state and the family's custody arrangement. Some states let minors consent to counseling on their own at a certain age. Check your state's rules and add a second signer role and signature field in the template editor when both parents must sign.
Can clients sign the consent form online?
Yes. Electronic signatures are valid for most agreements under federal and state law, and clients can read the form at their own pace before signing.
How often should I update it?
Whenever your fees, policies or contact methods change, and send the new version to current clients for a fresh signature.