and give my full consent to psychotherapy for my daughter/son. I understand that this document does not release information from the psychotherapist to me. I will refrain from requesting detailed information about individual therapy sessions with my child. I understand that I will be provided with periodic updates about general progress, and/or may be asked to participate in therapy sessions as needed.
I understand that I will be informed about situations that could endanger my child. I know this decision to breach confidentiality in these circumstances is up to the therapist’s professional judgment and may sometimes be made in confidential consultation with her consultant/supervisor.

Confidentiality
Mental health professionals are required by law to report incidents of child/elder and dependent abuse or intent to do physical harm to oneself or another, or threats to another’s property. While it is our legal responsibility to report any of the above, it is our ethical responsibility to help you through this trying time.
I have been informed that there is a fee for the sessions and I agree to be responsible for these payments. I understand that I may revoke this consent at any time.