Consent for Care

By signing the consent form, you consent to evaluation and treatment by your clinician. Together, you will discuss a treatment plan, expected benefits, risks and alternatives. Treatment may improve symptoms and daily functioning, but results are not guaranteed. Discussing difficult experiences or making changes can cause emotional discomfort or distress.

You may ask questions or decline a treatment. This general consent does not replace informed consent for a specific treatment or procedure. If medication is recommended, your prescribing clinician will discuss its benefits, risks, interactions, monitoring and alternatives before you decide.

Our Notice of Privacy Practices explains how we use and share health information and your privacy rights. Confidentiality has legal limits, including certain reports of abuse or neglect, serious threats to safety and legally required disclosures.

This consent does not replace a separate authorization where required, including for certain sensitive records or separately maintained psychotherapy notes. Our Practice Policies and Procedures explain scheduling and payment.

If you sign for another person, identify your relationship and legal authority. The practice may request documentation and will verify which decisions you can make. Authority to consent to care or medication and access to records depend on the service and applicable law.

When a child or teen is in care, the young person is our client. To help your child speak openly, the clinician generally shares overall themes, progress and recommendations with parents, rather than the details of what your child says in session. Your clinician will discuss what will and won't be shared at the start of care. Your clinician will tell you if there is a serious concern about your child's safety or someone else's, or when the law requires disclosure.

If parents share legal custody, either parent may usually consent to care, and we ask that the other parent be informed. If a court order limits either parent's authority, please share it with us before the first session. Information one parent shares with the clinician may be shared with the other parent when relevant to the child's care.

In California, minors 12 and older may consent to some mental health services on their own. When they do, their records and privacy are protected under the rules for that consent, and parents may not have access.

Psychologists

NOTICE TO CONSUMERS: The Department of Consumer Affair's Board of Psychology receives and responds to questions and complaints regarding the practice of psychology. If you have questions or complaints, you may contact the board by email at bopmail@dca.ca.gov, on the Internet at www.psychology.ca.gov, by calling 1-866-503-3221, or by writing to the following address: Board of Psychology, 1625 North Market Boulevard, N-215, Sacramento, CA 95834.

Physicians and psychiatrists

NOTICE TO CONSUMERS: Medical doctors are licensed and regulated by the Medical Board of California. (800) 633-2322 www.mbc.ca.gov