Informed consent form model for therapists

A useful informed consent form model for therapists structures the conversation but does not replace it. The document should be understandable, specific to the service, and easy to revisit.

There is no universal wording for every practice. Use this structure as a review checklist.

Before preparing the document, read the general guide to informed consent in therapy.

Suggested structure

Identity and service

Identify the professional, the person receiving care, and any representative. Describe the broad nature, format, frequency, and limits of the service without promising outcomes.

Confidentiality and data

Explain confidentiality and its limits. State what information is collected, why, who can access it, how long it is retained, and how rights may be exercised. A generic statement that someone “accepts GDPR” is not enough.

Administrative conditions

Keep fees, cancellation terms, communication, reminders, and billing separate from clinical choices. Identify who receives administrative information where another person pays.

Optional choices

Separate online care, communication channels, coordination with third parties, and session recording. See online therapy and session recording consent.

Acceptance and withdrawal

Record the version, date, identity and capacity of the signer, and how a permission can be withdrawn.

I confirm that I have received understandable information about the proposed therapy service, its format, conditions, confidentiality, and limits. I have been able to ask questions. Optional permissions are recorded separately.

This sample must be completed and adapted. It does not prove by itself that an informed conversation occurred.

Clara lets you share the form, retain responses and signature, and keep its status with the clinical record. Explore consent management for therapists.

Official sources

• Spanish Law 41/2002, BOE.
• Regulation (EU) 2016/679, EUR-Lex.

Information reviewed on September 5, 2026.