MindMed Informed Consent and Disclaimer
Review the educational-only disclaimer, telehealth limits, and confidentiality terms, then confirm consent and sign electronically.
Acknowledgement: The screening tools provided are for educational purposes only and do not constitute a medical or psychological diagnosis.
Disclaimer: MindMed is not an emergency or crisis intervention service. If you are experiencing an emergency, please contact the appropriate emergency services.
Participation in MindMed services is entirely voluntary. You may withdraw at any time without penalty.
Information provided may be used to coordinate therapist booking and related services.
Confidentiality Statement: All personal information will be kept confidential in accordance with applicable privacy laws and regulations.
Telehealth Limitations: While telehealth services offer convenience, there may be limitations regarding privacy, technology failures, and the inability to respond to emergencies.
Emergency Instructions:
If you are in immediate danger or need urgent support, please call
112
or the Mental Health Helpline at
081-6913-7108
.
Electronic Signature
*
Date
*
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Month
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Day
Year
Date
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
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