Most consent forms you'll find online are either one clinic's PDF, written for its own state and services, or a short form full of blanks. Below is a complete informed consent example counseling and therapy practices can copy and adapt: every section a private practice needs, in plain words, one line per field. After the template, each section is explained with the ethics standard behind it, followed by the basics of HIPAA's Notice of Privacy Practices, a list of what to check with your state board, and a short way to go over consent in the first session.
One warning before you copy anything: consent law varies by state. Who must report what, whether you must warn a person your client threatens, the age at which a minor can consent to therapy, how long you keep records and what your form must say all come from your state's laws and your licensing board's rules. Treat the template as a starting point and check it against your state board's rules before a client signs it. This article is general information, not legal advice, and every client mentioned in it is invented.
What informed consent in therapy is, and what the form is for
Informed consent is a process: you explain how therapy with you works, the client understands it and agrees, freely, and you both keep talking about it as therapy changes. The signed document is the record of that process, not the process itself.
All three major US ethics codes say this in their own words:
- Counselors.The ACA Code of Ethics says clients "need adequate information about the counseling process and the counselor," that counselors review rights and responsibilities with clients "in writing and verbally," and that "informed consent is an ongoing part of the counseling process" (ACA Code of Ethics, A.2.a).
- Psychologists.The APA Ethics Code asks psychologists to inform clients "as early as is feasible" about "the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality," and to give them a real chance to ask questions (APA Ethics Code, 10.01).
- Social workers.The NASW Code of Ethics asks for "clear and understandable language" about the purpose of services, risks, limits set by a third-party payer, costs, reasonable alternatives, the client's right to refuse or withdraw consent, and the time frame the consent covers (NASW Code of Ethics, 1.03).
Marriage and family therapists have their own code (AAMFT), and many state boards adopt one of these codes into their rules, which makes it enforceable for licensees in that state. The codes don't require one particular form, but a signed, dated document is the clearest evidence that the conversation happened, and some states do require a written disclosure. Colorado, for example, requires psychotherapists to give a written disclosure statement at the first contact and have the client sign it no later than the second visit (C.R.S. 12-245-216).
One note on versions: the ACA is revising its 2014 code and has said the new version will be published in fall 2026. Until it is, the 2014 code is the one on ACA's website. Check for the new version before you cite section numbers in your own form.
What every informed consent document should cover
Put the three codes side by side and you get the list below. The template that follows covers all of it.
- The service: what you offer, your approach, how long and how often, what the first sessions look like (ACA A.2.b, APA 10.01(a), NASW 1.03(a)).
- Benefits, risks and alternatives: the ACA lists risks and benefits (A.2.b), and the NASW adds reasonable alternatives (1.03(a)).
- Your qualifications and supervision: your license, and your supervisor's name if you're pre-licensed (ACA A.2.b, APA 10.01(c)).
- Confidentiality and its limits, at the start and again when circumstances change (ACA B.1.d, APA 4.02, NASW 1.07(e)).
- Fees, billing and what happens if a bill isn't paid (ACA A.2.b, APA 6.04, NASW 1.03(a)).
- Technology: video sessions, email, text and social media (ACA A.2.b and H.2.a, APA 4.02(c), NASW 1.03(e) to (g)).
- Records: what you keep and how the client can see it (ACA A.2.b and B.6.e).
- What happens if you can't continue, through illness or death (ACA A.2.b and B.6.i).
- The right to refuse or stop any service at any time (ACA A.2.b, NASW 1.03(a)).
- Consent for people who can't give it themselves, such as minors, with their assent (ACA A.2.d, APA 3.10(b), NASW 1.03(c)).
The informed consent template (copy and adapt)
Copy the block below into your own document. Fill in or delete everything in square brackets, remove the sections you don't need (for example minors, if you only see adults), and keep the numbering so you can refer to sections in conversation. It is written in the first person for a solo private practice; a group practice can change "I" to "we" and add each clinician's details.
The template is long because it is complete. If you'd rather keep the main document short, move telehealth (section 4) and the fee schedule (section 3) into documents of their own and point to them, as many practices do. What matters is that nothing is missing and the client can find each answer.
What each section does, and the ethics code behind it
1Services and approach
This section answers the questions every code lists first: what therapy with you involves, what it might do, what it might cost the client emotionally, and what else they could do instead. The ACA lists "the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services" along with your qualifications and approach (A.2.b). The NASW adds "reasonable alternatives" and the client's right to refuse or withdraw (1.03(a)).
Three lines in it are easy to forget:
- Supervision.If you're pre-licensed, the APA requires that the client be told you're in training and given your supervisor's name (10.01(c)). Counselor and social work boards generally expect the same.
- Recording.The ACA (B.6.c), the APA (4.03) and the NASW (1.03(h)) all require permission before you record a session.
- What happens if you can't continue.The ACA lists "continuation of services upon the incapacitation or death of the counselor" as part of consent (A.2.b) and asks counselors to name a records custodian when appropriate (B.6.i). The name in that line should be a real colleague who has agreed, in writing, to do it.
If you use an approach that isn't yet well established, the APA asks you to say so, along with the risks and alternatives (10.01(b)).
2Confidentiality and its limits
This is the section clients remember least and boards look at most. The ACA asks counselors to explain the limits of confidentiality "at initiation and throughout the counseling process" (B.1.d), the APA asks psychologists to discuss them "at the outset" and again "as new circumstances may warrant" (4.02(b)), and the NASW asks social workers to review when disclosure "may be legally required" (1.07(e)). "Confidentiality has some limits" doesn't meet any of these. Name each exception.
- Danger to self.HIPAA permits a disclosure that you believe in good faith is needed to prevent or lessen "a serious and imminent threat," to a person able to help, "consistent with applicable law and standards of ethical conduct" (45 CFR 164.512(j)). The template says "may" because in most situations this is a judgment you are allowed to make, not a duty.
- Danger to others.Duty-to-warn and duty-to-protect laws differ more from state to state than almost anything else in this document: some states require you to act, some allow it, and a few say nothing. Fill in the bracketed line from your state's law, and describe what you would actually do.
- Abuse reporting.Every state requires therapists to report suspected child abuse and neglect, and HIPAA allows the report (164.512(b)). Many states add older adults, dependent adults or people with disabilities, and some add other categories. List what your state requires.
- Court orders and subpoenas.A court order and a subpoena are not the same thing. Under HIPAA, records can go out under a court order, but a subpoena on its own needs more, such as notice to the client (164.512(e)), and your state's privilege law may protect the records further. The ACA asks counselors who receive a court order to seek the client's written consent or take steps to limit the disclosure (B.2.d). Before you answer any subpoena, call your malpractice insurer's risk line or a lawyer.
- Couples, families and groups.The ACA asks you to define who "the client" is in couples and family work (B.4.b), and the NASW asks you to agree on how information shared by one person is handled and to say you can't make every member keep it private (1.07(f)). Many couples therapists use a "no secrets" policy: anything one partner says alone may be raised in a joint session. Whatever your policy is, write it down here.
The last line, about meeting in public, isn't in any code. Clients often worry about it, and one sentence answers it.
3Fees, payment and cancellation
The APA asks for an agreement on "compensation and billing arrangements" as early as feasible (6.04(a)), a discussion of any limits you can foresee because of the client's funding (6.04(d)), and a warning before you send a bill to collections, with a chance to pay first (6.04(e)). The ACA asks you to explain fees, billing and "procedures for nonpayment of fees" (A.2.b). The NASW lists "relevant costs" in consent (1.03(a)).
Two points come from outside the ethics codes:
- Good faith estimates.Under the No Surprises Act, a client who isn't using insurance can usually get a good faith estimate of expected charges if they ask for one or schedule at least three business days ahead (CMS: good faith estimates). The estimate is its own document; the consent form only tells the client they can get one.
- Missed-session fees and insurance.Insurers don't pay for sessions that didn't happen, and some payer contracts limit what you can charge their members. Check your contracts before you set the late cancellation line, and charge the same way for everyone.
4Telehealth
HHS's telehealth guidance notes that most states require informed consent before treatment by telehealth, and that it can be documented in writing or electronically before the session, or verbally at the start of each one (HHS: informed consent for telebehavioral health). The ACA lists what to add for distance counseling: your credentials and location, risks and benefits, what happens if the technology fails, response times, emergency procedures, time zone differences, possible denial of insurance benefits and your social media policy (H.2.a). The NASW asks social workers to verify each client's identity and location (1.03(f)) and to help clients who don't want remote services find another way (1.03(g)).
The location lines carry the most weight. Most state boards treat the session as happening where the client is, so you need a license (or a compact privilege) for that state, and your emergency plan only works if you know the address. HHS recommends recording the client's location and local emergency numbers before the first video session and confirming the address at each visit (HHS: telehealth emergency plan).
If HIPAA applies to you, the video platform is a business associate and needs to sign a business associate agreement with you.
5Email, text and other messages
HHS says HIPAA doesn't ban unencrypted email with clients, but you need reasonable safeguards, such as checking the address and limiting what you send. If a client may not know the risks, you can explain them and let the client decide whether to keep using email; if a client finds unencrypted email unacceptable, offer another way (HHS email FAQ). Section 5 of the template gives that explanation in two lines. The APA asks psychologists who work by electronic transmission to tell clients about "the risks to privacy and limits of confidentiality" (4.02(c)), and the NASW asks social workers to discuss their technology policies (1.03(e)).
Social media belongs here because the ACA makes it part of consent: counselors "clearly explain to their clients, as part of the informed consent procedure, the benefits, limitations, and boundaries of the use of social media" (H.6.b). The NASW asks for consent before an electronic search on a client, except to protect someone from serious harm (1.03(i)).
6Records and access
The ACA gives clients the right "to obtain clear information about their records" (A.2.b) and asks counselors to provide reasonable access to them (B.6.e). If HIPAA applies, clients have a right to see and get a copy of their record, and you must act on a request within 30 days, with one 30-day extension if you explain the delay in writing (45 CFR 164.524). Psychotherapy notes, if you keep them separately, are excluded from that right of access. Your progress notes are not psychotherapy notes: our DAP notes guide explains the difference.
How long you keep records is set by your state and your board, not by HIPAA, and the rule for minors is often longer than for adults. Fill in your state's number.
7Emergencies
A consent form that gives only your office number leaves clients guessing on the night they need help. Say plainly that you don't provide 24-hour crisis care, then give the numbers that do: 911 or the nearest emergency room, and the 988 Suicide and Crisis Lifeline, which takes calls and texts at 988 and chats at 988lifeline.org. Add a local crisis line if your county has one. The ACA asks counselors to arrange for continuity of care during vacations and illness (A.12), which is why the template names who covers for you.
Consent is the place to agree on emergency contacts, not the moment you need one. Say when you would call that person, and keep the promise narrow.
8Clients under 18
The ACA asks counselors to seek the assent of minors and include them in decisions as appropriate (A.2.d). The APA asks psychologists to explain the service, seek assent and consider the person's preferences when someone can't legally consent (3.10(b)), and the NASW asks social workers to get permission from an appropriate third party while informing the client at their level of understanding (1.03(c)).
The law here is state law, and it varies a lot. In some states a minor of a certain age can consent to outpatient therapy alone; in others a parent must. Under HIPAA, a parent is usually the child's personal representative, but there are exceptions, including when state law lets the minor consent and the minor does (HHS: personal representatives). For separated or divorced parents, the custody order or parenting plan tells you who can consent, so ask for it before the first session.
The "what parents hear" lines matter more than any other part of a minor's consent. Agree on them with the parent and the young person together, and write them down.
9Questions and complaints
None of the ethics codes requires a complaints section, but it makes the document honest, and some states require it. California, for example, requires therapists licensed by its Board of Behavioral Sciences to give clients a written notice that the board receives complaints, with its contact details (California BBS required notice). The HIPAA privacy notice must tell clients they can complain to you and to the HHS Secretary and that they won't be retaliated against (HHS: filing a complaint); the template repeats that in one line.
10Signatures
The signature lines record what the client agreed to, section by section, so they can't miss the parts that cost money or limit privacy. Leave room for both parents when your state or a custody order requires both, and for a minor's agreement in their own words. If clients sign online, electronic signatures are generally valid under federal and state e-signature laws, but check whether your board has its own rule. The "reviewed again" line is there because consent is ongoing: use it whenever you go back over the document.
HIPAA's Notice of Privacy Practices: the basics
The Notice of Privacy Practices is not informed consent. It is a separate document that HIPAA requires of covered entities, and it explains how you use and share health information and what rights clients have. HIPAA doesn't require a consent-to-treatment form at all; ethics codes and state law do.
- Whether it applies to you.HIPAA covers a provider who sends health information electronically in a standard transaction, such as an insurance claim (HHS: covered entities). A therapist who only sees self-pay clients may not be covered, but many follow HIPAA anyway so nothing changes the day they bill a plan. Our therapy intake form guide covers the covered-entity test in more detail.
- What it must say.In plain language: how you may use and disclose information, the client's rights and how to use them, your legal duties, how to complain to you and to HHS, a contact person, and an effective date. It also opens with a required header statement (HHS: Notice of Privacy Practices; 45 CFR 164.520).
- When to give it.No later than the first session. If the first service happens online, send the notice electronically, automatically, in response to the client's first request for service. Make a good faith effort to get a written acknowledgment that they received it, and note why if you couldn't.
- Where to post it.If your practice website describes your services, post the notice there prominently, and keep a copy at your office.
- How long to keep the paperwork.HIPAA documentation, such as your notice and acknowledgments, is kept for six years from when it was created or last in effect (45 CFR 164.530(j)).
- A 2026 update.As of February 16, 2026, HHS requires covered entities to include information about substance use disorder records (42 CFR Part 2) in their notice, and it revised its model notices in February 2026 (HHS: model notices of privacy practices). If your notice is older than that, start from the current HHS model.
- Keep releases separate.A HIPAA authorization to share information can't be combined with other documents into a "compound authorization," with narrow research exceptions (45 CFR 164.508(b)(3)). Your consent form explains when you share; a release of information gives permission for a specific disclosure, on its own form.
Consent law varies by state: what to check with your board
Before a client signs, check each of these against your state's law and your board's rules. Your licensing board's website usually links to the statutes and rules for your license; your professional association's state chapter, your malpractice insurer's risk management line and a health care lawyer can answer what the rules don't.
- Required disclosures. Does your board require specific content or a specific form, such as Colorado's disclosure statement or California's board notice?
- Duty to warn or protect. Is it required, allowed or not addressed, and what counts as a threat?
- Mandated reporting. Which groups beyond children: older adults, dependent adults, people with disabilities? Anything else?
- Minors. At what age can a minor consent to outpatient therapy? What can parents see? What does a custody order change?
- Records. How many years after the last session, and how long for minors?
- Privilege and subpoenas. What protects therapy records in your state's courts, and what do you do when a subpoena arrives?
- Telehealth. Does your state require a separate telehealth consent, and what are the rules when a client is in another state?
- Fees. Any limits on cancellation fees, collections or charging insured clients?
- Electronic signatures. Does your board accept them for consent?
- Your code. Which ethics code has your board adopted, and is a new version coming?
How to go over consent in the first session
Sending the document ahead lets the client read it at home. Going over it together turns it into consent. Ten minutes is usually enough.
- Send it before the first session, so the client has read it and can bring questions.
- Cover the four parts clients most often misunderstand: the limits of confidentiality, the cancellation fee, what to do in a crisis, and that they can stop at any time.
- Ask the client to say the confidentiality exceptions back in their own words. If they can't, explain again in different words.
- Ask "What questions do you have?" instead of "Any questions?" The first invites them; the second invites a no.
- Write it in your note. Our progress notes cheat sheet has wording for documentation, and a line like the one below is enough.
An example note line, for an invented client we'll call Dana, at a first session by video:
Reviewed informed consent with client before beginning: services and approach, limits of confidentiality (danger to self or others, abuse reporting, court orders), fees and the 24-hour cancellation policy, the telehealth emergency plan (client at home in Ohio; emergency contact her sister) and email policy. Client asked whether her employer could find out she is in therapy; explained that I share nothing without her written permission except as listed. Client restated the exceptions in her own words and signed the consent electronically before the session.
When to update consent and sign again
The codes treat consent as ongoing, so go back to the document when something material changes, not on a calendar. Use the "reviewed again" line, or have the client sign a new version, when:
- Your fees, cancellation policy or payment terms change.
- You start or stop seeing the client by video.
- A supervisor, associate or co-therapist joins the client's care.
- Individual therapy becomes couples or family therapy, or the other way around.
- The client moves to another state, or will be in one for a while.
- A minor client turns 18.
- You change how you keep records, communicate or bill.
- Your state changes a rule that the document describes.
Common informed consent mistakes
- Vague limits."There are some exceptions to confidentiality" names nothing. List them.
- Legal language.A client can't agree to what they can't follow. Short sentences, one idea each, second person.
- One signature, years old.A form signed before your fees or your telehealth practice changed documents agreement to something that no longer exists.
- No emergency plan for video sessions.Without the client's location and a local emergency number, the plan doesn't work.
- A missing supervisor.Pre-licensed clinicians must name their supervisor.
- Releases merged into consent.A release of information goes on its own form.
- Promises you can't keep."I will always respond within an hour" or "everything you say stays between us" will be broken one day. Promise what you'll actually do.
- A national template, unchanged.Reporting duties, minors and records rules are state law. A form that never mentions your state hasn't been checked against it.
How this works in TranqBay
TranqBay is practice software for therapists in private practice: a practice website, online booking, video sessions, session notes and a form library in one place. Here is where informed consent fits.
- A consent-to-treat template in the form library.The library has ready-made templates, including consent to treat, telehealth consent and release of information, alongside intake forms and screeners such as the PHQ-9 and GAD-7. You send forms to a client for a session, and the client reads and signs online before the session.
- Answers wait with the session.When the client has completed a form, you can see it from that session, so you know consent is in place before you meet.
- Compare it with your own document.Read the consent-to-treat template against the full document above and your state's rules before you send it. Your complete written consent, with your state's details, is still yours to give the client.
- Video sessions.Sessions run by video in the browser, and TranqBay signs a business associate agreement with you. You can read TranqBay's business associate agreement before you name the platform in section 4.
To see what a new client sees before a first video session, including the reminders to find a quiet, private space and check their camera and mic, look at the booking walkthrough on practice.tranqbay.health. It's a useful check on whether your telehealth section matches what clients are told.
Frequently asked questions about informed consent in therapy
Is informed consent legally required for therapy?
The informed consent process is required by every major ethics code, and many state boards adopt a code into their rules, which makes it enforceable. Some states also require specific written disclosures. Whether a signed form is required by law depends on your state; check your board's rules.
Does informed consent have to be signed?
The codes require the process and its documentation, not a particular signature. Some states do require a signature, Colorado's disclosure statement among them. Everywhere else a signed, dated document is still the clearest record that consent happened, so most therapists use one.
What is the difference between informed consent and the Notice of Privacy Practices?
Informed consent explains how therapy with you works and records the client's agreement to it. The Notice of Privacy Practices is a HIPAA document that explains how health information is used and shared and what rights the client has. If HIPAA applies, you need both, as separate documents.
Is "consent to treat" the same as informed consent?
Usually, yes. Many practices call the signed document a consent to treat, a client services agreement or a disclosure statement. The name matters less than the content: services, risks and alternatives, confidentiality and its limits, fees, and the right to stop.
Do I need a separate telehealth consent form?
HHS notes that most states require informed consent before telehealth. You can include it in your main document, as the template does, or use a separate form. Check whether your state requires a separate one.
How often should informed consent be updated?
Whenever something material changes: fees, the format of sessions, who is involved in care, where the client lives, or a minor turning 18. There's no need to re-sign on a fixed schedule if nothing has changed.
What should the confidentiality section include?
Each exception by name: danger to self, danger to others, suspected abuse or neglect, court orders, and the routine sharing for consultation, insurance, collections and software providers. Use your state's terms, and say what you would actually do.
Can a minor consent to therapy?
It depends on the state. In some states a minor of a certain age can consent to outpatient therapy alone; in others a parent or guardian must. Either way, ask for the young person's agreement in their own words.
What if a client won't sign the consent form?
Don't start treatment until you've talked it through. Ask which part concerns them; often it's one line, such as the cancellation fee or a confidentiality exception. If you can't agree, offer referrals.
Can clients sign informed consent electronically?
Generally yes: federal and state e-signature laws give electronic signatures the same weight as written ones in most settings. Check whether your board has its own rule, and record the date and how the client signed.
Before your next new client
Copy the template, fill in your state's details, and check it against your board's rules (and with a lawyer, if you can) before anyone signs it. Then send it before the first session and go over the four parts clients most often misunderstand. If you're also building the rest of your new-client packet, our therapy intake form guide has a template you can copy and the questions to save for the first session.
If you want booking, video sessions, forms and session notes in one place, see how TranqBay works for private practice: you can look at a practice website template and the booking confirmation a new client sees before a first video session. If you're deciding whether to join, this page explains how joining TranqBay works.
Sources
Associations 4HHS 8Regulations 1CMS 1States 1988 Lifeline 1
Professional associations4
- 1American Counseling Association, 2014 ACA Code of Ethics (A.2, A.12, B.1.d, B.2, B.4.b, B.6, H.2.a, H.6.b)counseling.orghttps://www.counseling.org/docs/default-source/default-document-library/ethics/2014-aca-code-of-ethics.pdf
- 2American Psychological Association, Ethical Principles of Psychologists and Code of Conduct (3.10, 4.02, 6.04, 10.01)apa.orghttps://www.apa.org/ethics/code
- 3APA Services: informed consent guidance and templates for psychologistsapaservices.orghttps://www.apaservices.org/practice/business/management/informed-consent
- 4National Association of Social Workers, Code of Ethics: Ethical Responsibilities to Clients (1.03, 1.07)socialworkers.orghttps://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English/Social-Workers-Ethical-Responsibilities-to-Clients
U.S. Department of Health and Human Services8
- 5Notice of Privacy Practices for Protected Health Informationhhs.govhttps://www.hhs.gov/hipaa/for-professionals/privacy/guidance/privacy-practices-for-protected-health-information/index.html
- 6Model Notices of Privacy Practiceshhs.govhttps://www.hhs.gov/hipaa/for-professionals/privacy/guidance/model-notices-privacy-practices/index.html
- 7Covered Entities and Business Associateshhs.govhttps://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
- 8Personal Representativeshhs.govhttps://www.hhs.gov/hipaa/for-professionals/privacy/guidance/personal-representatives/index.html
- 9email with patients (FAQ)hhs.govhttps://www.hhs.gov/hipaa/for-professionals/faq/570/does-hipaa-permit-health-care-providers-to-use-email-to-discuss-health-issues-with-patients/index.html
- 10Filing a Health Information Privacy Complainthhs.govhttps://www.hhs.gov/hipaa/filing-a-complaint/index.html
- 11HHS Telehealth: informed consent for telebehavioral healthtelehealth.hhs.govhttps://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/preparing-patients-for-telebehavioral-health/informed-consent-for-telebehavioral-health
- 12HHS Telehealth: creating an emergency plan for telebehavioral healthtelehealth.hhs.govhttps://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/preparing-patients-for-telebehavioral-health/creating-a-telehealth-emergency-plan