Mental Health Informed Consent template

1. Nature of Treatment

• I have been informed of the nature of the assessment or treatment being offered, including its purpose, likely approach, and expected duration.

2. Risks and Benefits

• Mental health treatment can involve discussing distressing experiences and may bring up difficult emotions before improvement occurs. Many clients experience meaningful benefit, though outcomes cannot be guaranteed.

3. Confidentiality and Its Limits

• Information shared is confidential, except where there is a risk of serious harm to myself or others, a safeguarding concern regarding a child or vulnerable adult, or a legal requirement to disclose. My provider may discuss anonymised material with a supervisor or multidisciplinary team.

4. Risk Assessment and Safety Planning

• I understand my provider may ask about risk to myself or others as part of standard care, and that a safety plan may be developed collaboratively if needed.

5. Data Protection

• Records are stored securely and processed under the UK GDPR and Data Protection Act 2018. I may request access to my records at any time.

6. Right to Withdraw

• I understand I may withdraw consent to treatment at any time, other than where treatment is required under the Mental Health Act 1983 or other legal authority.

Client Information

• Full NameText
• Date of BirthDate
• AddressText
• Phone / EmailText

Clinician Information

• Clinician NameText
• Registration No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Clinician SignatureSignature
• Date signed (clinician)Date

• By signing below, I confirm I have read and understood this consent form and voluntarily agree to begin treatment.