CONSENT AND AGREEMENT FORM FOR ASSESSMENT AND TREATMENT, PSYCHIATRY AND THERAPY AT MINDOF

By signing below, you certify that you have read, understood, and agree to the terms and conditions outlined in the Assessment and Treatment document, available at www.mindof.uk/consent-form.

By signing, you acknowledge the following:

1. Scope of Services: You understand the nature of the services provided and agree to the therapeutic approach described.

2. Payment and Cancellation Policy: You are aware of the payment structure, including fees for services, and agree to abide by the cancellation and non-attendance policies.

3. Confidentiality: You are aware of the confidentiality policies regarding your medical records and personal information, with exceptions as outlined in the document (e.g., legal obligations, emergencies).

4. Medical Records: You acknowledge the storage and management of your medical records and understand how these will be maintained and protected.

5. Communication: You agree to the outlined communication policies regarding sessions, follow-ups, and any digital communication.

   
   
   
   
   
   

SHARING INFORMATION CONSENT

I consent to any relevant information being forwarded to the following contacts (please tick the relevant boxes):

Purpose of Information Sharing: The information shared will be relevant to your care and treatment and may include details about your diagnosis, progress, or treatment plan. It will be shared only with those who need to know in order to facilitate your care and support.

I understand that I have the right to revoke this consent at any time, and that such revocation will not affect information shared prior to the withdrawal of consent.

By signing, you confirm that you are entering into a therapeutic relationship and agree to follow the terms as outlined.