Mental Health Treatment Consent Form
Asks about therapist or provider name, type of treatment, and confidentiality limits acknowledged. Built for onboarding new therapy or counseling patients with informed consent.
- Questions
- 11
- Pages
- 2
- Time
- about 3 min
Includes
- E-signature
- Consent agreement
- Emergency contact
Your practice
Mental Health Treatment Consent Form
Page 1 of 2 · Your information
Emergency Contact
Live preview. Tap through it like a patient.
Who it is for
- Onboarding new therapy or counseling patients with informed consent
- Documenting confidentiality limits and mandatory reporting obligations
- Establishing session expectations and cancellation policies
- Meeting licensing board requirements for mental health informed consent
What's inside
Before you publish: Add your practice-approved consent wording before publishing.
Page 1 · Your information
- Patient Full NameText · Required
- Date of BirthDate
- Therapist or Provider NameText
- Type of TreatmentLong Text
- Confidentiality Limits AcknowledgedLong Text
Page 2 · Additional details
- Emergency Contact PhonePhone
- Cancellation Policy AcknowledgedLong Text
- Consent to TreatmentConsent Agreement
- Patient SignatureE-Signature
- Date of ConsentDate
From form to a ready patient

01
Make it yours
Reword, reorder, or add to the Mental Health Treatment Consent Form, and add your logo.

02
Patients finish it at home
A secure link by text or email, filled out on their phone before the visit. No app.

03
Your team sees who is ready
Each visit shows as ready once its forms are in. Answers land on the patient record.
Related templates
All templatesMental Health Intake FormIntake · 13 questions
Mental Health History FormMedical History · 18 questions
Substance Abuse Treatment Consent FormConsent · 12 questions
Mental Status Examination (MSE)Assessment · 16 questions
PHQ-9 Depression ScreeningScreening · 13 questions
Anesthesia Consent FormConsent · 10 questions
Questions
Send it before the visit, so patients arrive ready.
Add the Mental Health Treatment Consent Form to your account and make it yours in a few minutes.
Cancel anytime · BAA included