I hereby give permission to the therapistClinical
Psychologist to interview, assess and treat myself according to the guidelinesterms mentioned below:
These services, which upon request will be explained to me, may include individual, group, play, maritalcouples and family therapycounseling, consultation and psychological testingassessment. The TherapistClinical Psychologist reserves the right to refuse involvement in ongoing future Forensicmedico-legal consultationassessmentevaluation, especially if the said was not divulged at the beginning of the therapeutic process . I realise that psychology is an imperfect science and that a particular benefit or outcome cannot be guaranteed. I understand that in order to achieve the best results, I may need to confront troubling feelings and that I may feel worse before I start to feel better. I am seeking this treatment of my own accord and am free to discontinue therapythese services at any time and ask for a referral.
Furthermore, I understand and agree to the following terms:
My signature below indicates that I have read and fully understand the contents of this Informed Consent FormProfessional Agreement and agree to its terms. In addition, I also understand my therapistClinical Psychologist explanations and answers to all (if applicable) of my questionsconcerns at this point. My signature indicates that I give my full consent to treatment.
This is not an actual appointment form. The below form is to request an appointment. We will get back to you to confirm if the requested date and time is available.