The Consent Form Template Psychology UK is offered in multiple formats including PDF, Word, and Google Docs, and features customizable and printable samples for your needs.
Consent Form Template Psychology UK Editable – PrintableSample
Consent Form Template Psychology UK 1. Client Information 2. Practitioner Information 3. Purpose of Assessment/Treatment 4. Description of Procedures 5. Risks and Benefits 6. Confidentiality Statement 7. Limitations of Confidentiality 8. Consent to Treatment 9. Patient Rights 10. Declaration and Signatures Please note: If the client is under 18, a parent or guardian must also sign below.
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WORD
Examples
[Client’s Full Name]
[Client’s Date of Birth]
[Client’s Address]
[Client’s Phone Number]
[Client’s Email Address]
[Practitioner’s Name]
[Practitioner’s Qualifications]
[Practitioner’s Registration Number]
[Practitioner’s Address]
[Practitioner’s Phone Number]
This consent form outlines your agreement to participate in psychological assessment and therapy, which may include various psychological tests, interviews, and treatment techniques.
The proposed assessment/treatment will involve the following methods: [List specific methods, e.g., cognitive-behavioral therapy, psychological testing]. It aims to address your concerns regarding [Specify issues, e.g., anxiety, depression].
All information provided will be kept confidential and stored securely in compliance with GDPR regulations, except where disclosure is required by law or with your explicit consent.
Potential risks include [Mention any possible risks, e.g., emotional discomfort], while benefits may include [List possible benefits, e.g., improved mental health, coping strategies].
You have the right to withdraw your consent and discontinue services at any time without any negative consequences.
By signing this form, you acknowledge that you have read and understood the information provided and consent to participate in the outlined assessment and treatment.
[Client’s Signature]
[Client’s Full Name]
[Practitioner’s Signature]
[Practitioner’s Name]
[Client’s Full Name]
[Client’s Date of Birth]
[Client’s Address]
[Client’s Phone Number]
[Client’s Email Address]
[Practitioner’s Name]
[Practitioner’s Qualifications]
[Practitioner’s Registration Number]
[Practitioner’s Address]
[Practitioner’s Phone Number]
The purpose of this consent form is to ensure that you are fully informed about the assessment and treatment process, your rights, and the use of your information.
The services offered will include [Describe services, e.g., individual counseling sessions, group therapy, psychological evaluations], focusing on [Describe issues, e.g., stress management, emotional regulation].
Your personal information will be treated confidentially and will not be shared with third parties without your consent unless required by law.
It is important to understand that while there are potential risks such as [List risks, e.g., discussing distressing topics], the advantages may include [List advantages, e.g., finding effective coping strategies, enhancing self-awareness].
Your consent is entirely voluntary, and you may withdraw at any time without jeopardizing your access to services.
By signing below, you affirm that you understand the information above and agree to participate in the assessment and treatment.
[Client’s Signature]
[Client’s Full Name]
[Practitioner’s Signature]
[Practitioner’s Name]
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