Consent form

Consent Form

Completing and signing our consent forms before counseling ensures a transparent, professional, and respectful process. These forms outline counseling's goals, confidentiality limits, and legal framework, protecting both you and our counselors. Your consent reflects our commitment to your well-being and a trustworthy therapeutic journey.

Name

First

Last

I have agreed to participate in this counselling session and I am aware that I may withdraw at any time, refuse any counselling techniques and ask my counsellor any questions regarding the therapy process.

Our counsellors are registered with the Health Professions Council of South Africa (HPCSA) and therefore abide by the limits of confidentiality as stipulated in the Health Professions Act No.56 of 1974. Which states that counselling sessions are completely confidential with the exception of:
• Evidence of abuse of any kind (Emotional, Physical, Sexual or Child Abuse)
• Evidence of suicidal thoughts or suicidal intention
• Evidence that I may hurt myself or somebody else
• The release confidential information upon court order or to conform with legal imperatives or upon the written authorization of the client, parent of a minor patient or client, or legal guardian.

I have read and understand the above information and give my consent for this counselling session.

Name and Surname of Emergency Contact:

First

Last

Emergency Contact Email

Emergency Contact Number

Signature

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Date

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