• PROFESSIONAL COUNSELLING INFORMED CONSENT FORM

  • I, Nidhi Vijay, am a Counselling Psychologist committed to providing a safe, confidential, and supportive space for personal growth and healing. My approach is trauma-informed and integrative, drawing from evidence-based modalities such as Cognitive & Behavioral Interventions, Humanistic-Existential Psychology, Mindfulness & Acceptance-Based Therapies, and Relational & Attachment-Based Interventions.

    This document outlines important information regarding the therapeutic process, your rights as a client, and policies related to confidentiality, fees, and session structure. Please review this carefully and feel free to discuss any concerns before signing.

  • Purpose of Counselling & Scope of Practice
    Counselling provides a supportive and structured environment to explore emotions, thoughts, and behaviors. As a therapist, my role is to facilitate insight, coping strategies, and personal growth. While therapy is a collaborative process, the client’s active participation is essential for progress.

    Confidentiality & Its Limits
    Confidentiality is a fundamental part of the therapeutic relationship. Information shared during sessions remains private, except in the following cases:

    When there is a risk of harm to yourself or others.
    If required by law (e.g., court orders, legal proceedings).
    In cases of suspected abuse, neglect, or harm to vulnerable individuals (children, elderly, or persons with disabilities).
    If you provide written consent to share specific information.

    Nature of Therapy & Potential Risks
    Therapy can involve discussing sensitive and difficult emotions, which may initially cause discomfort.
    Progress varies from person to person, and no specific outcome is guaranteed.
    Counselling is not a substitute for psychiatric care or emergency mental health services.

    Session Structure & Duration

    Sessions are typically 50-60 minutes in duration.
    The frequency of sessions will be determined collaboratively based on your needs.
    If adjustments to session schedules are required, they will be discussed in advance.

    Fees, Payment & Cancellation Policy
    Session Fee: ₹2000 per session
    Payment is to be made via UPI or Bank Transfer.
    Clients must inform at least 24 hours in advance for cancellations or rescheduling. Late cancellations or no-shows will be charged the full session fee.
    Payments are non-refundable, except in cases of emergencies, which will be considered on a case-by-case basis.

    For payment details, please reach out directly.

    Client Rights & Responsibilities
    You have the right to discontinue therapy at any time.
    You are encouraged to provide feedback regarding the therapeutic process.
    Therapy is most effective when approached with openness and commitment.

  •  - -
  • Acknowledgement

    I acknowledge that I have read and understood this informed consent form. I agree to the terms outlined and voluntarily consent to participate in therapy.

  • Powered by Jotform SignClear
  •  - -
  • Should be Empty: