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Consent Form 
Mind Splatters

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Mind Splatters - Mental Health Care and Well Being aims to provide services by qualified professionals to those who have mental health concerns, their families, and those involved in our community. As one of our mental health care services, we provide counseling or therapy sessions.

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Please read this important information about our services and policies carefully.

If you decide to participate the counseling services, please consent to it. 

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Please note- you must be over the age of 18 to avail our services.

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A Professional Counseling Informed Consent Form is a document provided by the counseling service to their clients in order to properly acquire consent from them treatment for mental health.

This document contains important information about our professional services and business policies.

 Please read it carefully and jot down any questions you might have so that you and your therapist can discuss them.

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When you consent to this document, it will represent an agreement between Mind Splatters and you.

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Our Responsibilities to you as your therapist -

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  1. Confidentiality

With the exception of certain specific exceptions described below, you have the absolute right to the confidentiality of your therapy. We cannot and will not tell anyone else what you have told us, or even that you are in therapy with us without your prior written permission.

The following are legal and non legal exceptions to your right to confidentiality. We would inform you of any time when we think we will have to put these into effect.

 

  1. Your therapist may consult with other counsellor / supervisors to provide the best possible care. These consultations are for professional purposes and your identity would not be revealed.

  2. If there is evidence of clear and imminent danger or harm to self and/or others, your therapist is legally required to report this information to the authorities responsible for ensuring safety.

  3. Disclosure of information, if required by law.

 

  1. Record-keeping.

Your therapist will keep very brief records, noting only that you have been here, what interventions happened in session, and the topics we discussed. These too will be kept confidential unless legal and non legal exceptions come into play.

 

  1. Risks and Benefits

While psychotherapy may provide significant benefits based on empirical evidence, it may also pose risks. Psychotherapy may elicit uncomfortable thoughts and feelings, or may lead to the recollection of troubling memories. Choosing not to engage in therapeutic treatment may also result in greater discomfort or escalating risks. We will give you the opportunity to express your feedback and communication about the therapy process and impact is crucial in reducing my risk for harm, and your therapist will encouraged you to communicate any concerns or discomforts with them as soon as is feasibly possible in my treatment.

 

Your rights as a client -

 

  1. You have the right to ask questions about anything that happens in therapy.

  2. Our therapists are always willing to discuss how and why they’ve decided to do what they’re doing, and to look at alternatives that might work better.

  3. You can ask your therapist about their training for working with your concerns, and can request them to refer you to someone else if you decide their not the right therapist for you.

  4. You are free to leave therapy at any time or ask for a referral.

 

General Policies -

  1. Individual therapy sessions last for 45minutes to 1 hour each.

  2. The fee for a session is fixed as seen on our website.

  3. Your therapist is only available at scheduled slots and will not be available otherwise unless an emergency session is required. You can book the same by contacting us on WhatsApp. (Prices for emergency sessions may differ). Emergency contacts will be provided if needed or can be found on our website

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Cancellation & Refund Policy for Appointment Bookings:

  1. If you decide to cancel the session at least 24 hours prior to the scheduled appointment, you will be eligible for a full refund. If it is done within the 24 hour it will be considered a no-show.

  2. You are responsible for coming to your session on time, your therapist will wait for 15 minutes post your booking time. If you join late, we will end on time and not run over into the next person's session. If you do not join it will be considered a no-show. 

  3. A no -show is if you miss a session without canceling, or cancel with less than twenty-four hours notice, the amount paid for the session will not be refunded.

  4. In case the service provider has to cancel a session, you will be refunded the entire amount paid, irrespective of when the session is cancelled.

  5. If you no-show for two sessions in a row and do not respond to our attempts to reschedule, we will assume that you have dropped out of therapy and will make the space available to another individual.

  6. If you book multiple therapy sessions with our offers and decide to leave our services, only 50% of the remainder amount will be refunded.

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If you wish to cancel or reschedule your session 24 hours or more before the session start, you can reach out to us at admin@mindsplatters.com or WhatsApp us at wa.me/9902833325

 

Client Consent to Psychotherapy

 I have read this statement, had sufficient time to be sure that I considered it carefully,  and understand it. I understand the limits to confidentiality required by law.  I understand my rights and responsibilities as a client, my therapist's responsibilities to me and the policies stated.

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 Please check the box on your bookings page if you agree to undertake therapy with Mind Splatters.

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Contact us

admin@mindsplatters.com

WhatsApp - 9902833325

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