Counselling Consent Form Template – Australia

Disclaimer

The information provided is intended solely as a general sample for a formal agreement regarding client consent in therapy or counselling services in Australia. It does not constitute legal advice and should not be relied upon as a substitute for consulting a qualified legal professional familiar with Australian laws and regulations related to healthcare and privacy. Laws and requirements may differ across regions, and modifications might be necessary to ensure compliance with local standards. The use of this sample is at the user’s own risk, and no liability is accepted for errors, omissions, or consequences arising from its use without professional legal review.

Please note: This is a sample Counselling Consent Form template for Australia, provided for guidance purposes only. Actual terms should be tailored to your specific practice and comply with relevant Australian laws.

Counselling Consent Form Sample – Australia

Client Details:

Name: ________________________________
Date of Birth: ___________________________
Contact Number: _________________________
Address: ________________________________

Nature of Services:

The purpose of this counselling is to provide psychological support and guidance to assist the client with personal, emotional, or mental health issues as discussed during sessions.

Consent to Treatment:

I, the undersigned, voluntarily agree to participate in counselling sessions provided by the counsellor. I understand the nature of the counselling process and acknowledge that my participation is voluntary.

Confidentiality:

All information shared during sessions is confidential unless disclosure is required by law or if there is a risk of harm to oneself or others. The counsellor will explain the limits of confidentiality at the outset.

Client Rights and Responsibilities:

The client has the right to withdraw consent at any time and to ask questions about the counselling process. The client agrees to be honest and to inform the counsellor of any concerns or issues that may affect the counselling sessions.

Emergency Contact:

Name: ________________________________
Phone Number: _________________________

Communication Methods:

Counselling sessions may be conducted in person, via phone, or through secure online platforms. The client agrees to the proposed methods of communication.

I have read, understood, and agree to the above terms of this counselling consent form.

Date: ________________________________