CONSENT FOR TREATMENT OF CHILDREN OR ADOLESCENTS

I/We consent that [minor listed below] may be treated as a client at Mindful Wellness Therapy, LLC. It is understood that children over the age of 12 have confidentiality protected by law. At times it may be necessary to schedule appointments during school hours. I ask for your cooperation to provide the most timely treatment for you and your children. This consent to treat expires at the end of treatment or if revoked in writing.

If you are under 18 years of age, please be aware that the law may provide your parents with the right to examine your treatment records. For those who are between 12 and 18 years of age, it is the policy of Mindful Wellness to request agreement from your parents that they consent to give up access to your records. If they agree, your therapist will provide them with only general information about your services unless your therapist feels that there is a risk of harm to yourself or others, in which case your therapist will notify them of this concern. Your therapist will also provide them with a summary of your treatment when it is complete if they have opted to let our work be confidential. Before giving them any information, your therapist will discuss the matter with you, if possible and will do their best to resolve any objections you may have about what we are prepared to discuss.


BENEFITS AND RISKS OF THERAPY

Therapy can lead to improved mood and life functioning. However, sometimes you may feel worse before you start to feel better. This is due to the fact that we may have to discuss and process unpleasant aspects of your life. Because of this, I request that you let me know if you start to incur any uncomfortable feelings and/or are questioning continuing therapy. While Mindful Wellness provides no guarantees of results, we do guarantee that our therapists will exercise their best professional efforts to help you. At any time should you decide that your therapist is not a good fit for you, we will be happy to provide you with a referral.