"Informed Consent for Psychotherapy" Intake Form
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I have written my Informed Consent for Psychotherapy document and I want to share it with the community.  This document was written for my practice located in California.  Please feel free to copy and use it with your practice (just remember to change the relevant information, especially the last paragraph, About the Therapist).  Any feedback you wish to offer will be well-received.  Just remember that I am not a forensic psychologist, attorney or legal expert.  This is just one of many possible concepts for an Informed Consent document that you are free to use and adjust to suit your needs.

Click here to view and print the PDF.

12 comments

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    Demetra Caston

    This is awesome.  Thanks for sharing.

    This is awesome.  Thanks for sharing.

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    Catherine M. Cotter

    Looks great. Appreciate the share!

     

    Looks great. Appreciate the share!

     

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    Erin Hickman

    Thank you!

    Thank you!

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    Thomas La Grave

    Tom L.

     

    Yes, this is what I've been looking for.  Thank you.

    Tom L.

     

    Yes, this is what I've been looking for.  Thank you.

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    Houman Nikgohar

    Thank you for sharing Ryan

    Thank you for sharing Ryan

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    Shirley Barthelemy

    This is great! Thanks for sharing. Would it be best to have each consent on separate forms?

    This is great! Thanks for sharing. Would it be best to have each consent on separate forms?

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    Julie P. Sanniota

    Thanks Ryan. I love the  personal yet professional tone of your statement.  I appreciate you sharing it!

    Thanks Ryan. I love the  personal yet professional tone of your statement.  I appreciate you sharing it!

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    Lori Lauridsen

    This is fantastic, thank you so much for sharing!

    This is fantastic, thank you so much for sharing!

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    David Flowers

    Nice, Ryan. It's incredibly similar to mine. Did you use the form from Dr. Ofer Zur as your basic template?

    I will be adding the telehealth section from your form to my own, thank you.

    Nice, Ryan. It's incredibly similar to mine. Did you use the form from Dr. Ofer Zur as your basic template?

    I will be adding the telehealth section from your form to my own, thank you.

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    Liz LaColla

    Thank you!!!

    Thank you!!!

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    Marsha McCleskey

    How do you input this document into the SP forms for intake etc.  

    How do you input this document into the SP forms for intake etc.  

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    Ryan Buchmann

    To make it a click-n-sign consent form, follow these steps:

    1. From within Simple Practice at the calendar screen, click My Account (look for the gear icon) > Settings > Notes and Forms (on the left).
    2. Click the blue button "Create New Template > Create New Template."
    3. On the right, click the drop down menu that says "for Progress Notes" and change it to "For intake forms."
    4. You are now positioned to create a form that can be clicked to sign.  Bear in mind, the text editing in this form designer is pretty limited (no bolding, underscore, or italicizing).
    5. Click the "Add new" button to create a new paragraph.  Click the dropdown that says "Long Answer" and change to "Paragraph Text."  This allows you to create a paragraph that doesn't require client input.  Copy & paste in your consent form here.
    6. Edit the form according to your needs.  Use all CAPS to emphasize certain statements.  You may want to add an e-signature to each paragraph to obtain evidence that the client read/looked at it.
    7. When you're done with the paragraph, click save.
    8. Click "Add New" again to add the e-signature line.  Click the dropdown and change "Long Answer" to "eSignature."  
    9. In the e-signature description field, enter a statement that essentially says something to the effect of "I read this and I understand it."  Click the checkbox "Require e-signature" so the client must click the signature box in order to submit the completed consent form.  Click Save to save the e-signature line.
    10. Return to the top of the form and click the Save button on the right to save the form.  Don't forget to give the form a name and display name.
    11. Your form is done.  It should appear in the list of intake forms (scroll down to see it).  Click the little eyeball icon on the right to preview it
    Edited by Ryan Buchmann

    To make it a click-n-sign consent form, follow these steps:

    1. From within Simple Practice at the calendar screen, click My Account (look for the gear icon) > Settings > Notes and Forms (on the left).
    2. Click the blue button "Create New Template > Create New Template."
    3. On the right, click the drop down menu that says "for Progress Notes" and change it to "For intake forms."
    4. You are now positioned to create a form that can be clicked to sign.  Bear in mind, the text editing in this form designer is pretty limited (no bolding, underscore, or italicizing).
    5. Click the "Add new" button to create a new paragraph.  Click the dropdown that says "Long Answer" and change to "Paragraph Text."  This allows you to create a paragraph that doesn't require client input.  Copy & paste in your consent form here.
    6. Edit the form according to your needs.  Use all CAPS to emphasize certain statements.  You may want to add an e-signature to each paragraph to obtain evidence that the client read/looked at it.
    7. When you're done with the paragraph, click save.
    8. Click "Add New" again to add the e-signature line.  Click the dropdown and change "Long Answer" to "eSignature."  
    9. In the e-signature description field, enter a statement that essentially says something to the effect of "I read this and I understand it."  Click the checkbox "Require e-signature" so the client must click the signature box in order to submit the completed consent form.  Click Save to save the e-signature line.
    10. Return to the top of the form and click the Save button on the right to save the form.  Don't forget to give the form a name and display name.
    11. Your form is done.  It should appear in the list of intake forms (scroll down to see it).  Click the little eyeball icon on the right to preview it