Template library · Consent & legal
Client Rights & Responsibilities template
A shared understanding of what to expect from each other.
A shared understanding of what to expect from each other.
- 8 fields across 8 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
1. Your Rights
- You have the right to be treated with dignity and respect; to receive clear information about your care or service; to ask questions and receive honest answers; to confidentiality within the limits explained to you; and to withdraw consent or end services at any time.
2. Your Responsibilities
- You agree to attend appointments on time or provide adequate notice of cancellation; to communicate openly and honestly with your provider; to disclose relevant health or safety information; and to treat staff and other clients with respect.
3. Complaints
- If you are unhappy with any aspect of your care, you may raise this directly with your provider, or in writing to the practice, and it will be addressed promptly and fairly.
4. Zero-Tolerance Policy
- Abusive, threatening, or discriminatory behaviour towards staff or other clients will not be tolerated and may result in immediate termination of services.
Client Information
- Full NameText
- Phone / EmailText
Provider Information
- Provider NameText
- Complaints ContactText
Emergency Contact
- Contact NameText
- Relationship / PhoneText
Acknowledgment and Signature
- Client SignatureSignature
- Date signed (client)Date
- By signing below, I confirm I have read and understood my rights and responsibilities as a client.
When to use it
Use a consent form before treatment starts, and again when what you are doing changes, so the client’s agreement is recorded in writing alongside their notes.
How it works in MyWellOps
- Edit the wording to match your service and your professional body’s guidance.
- Send it to the client to read and sign in their client portal; if it isn’t signed, they get an email reminder after 3 days.
- The signed copy stays on the client’s record.
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