Template library · Consent & legal
Group Therapy Confidentiality Agreement template
A shared commitment among all members of the therapy group.
A shared commitment among all members of the therapy group.
- 8 fields across 8 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
1. Purpose
- This agreement sets out each member's commitment to protecting the privacy of others in the group, so that everyone can share openly and feel safe.
2. Confidentiality Commitment
- I agree not to share the names, identities, or personal stories of other group members with anyone outside the group, including on social media, without their explicit permission.
3. Limits of This Agreement
- I understand this is a mutual commitment between members, not a legal guarantee, and that the facilitator cannot be responsible for another member's breach of confidentiality. Disclosure may still be required where there is risk of serious harm or as required by law.
4. Contact Outside the Group
- I agree to discuss with the facilitator before establishing separate outside relationships with other members that could affect group dynamics.
Member Information
- Full NameText
- Group Name / ProgrammeText
Facilitator Information
- Facilitator NameText
- Licence No.Text
Emergency Contact
- Contact NameText
- Relationship / PhoneText
Signature
- Member SignatureSignature
- Date signed (member)Date
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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