Free download
Free counselling consent form template.
This counselling consent form is a ready-to-edit template for South African practitioners. It sets out what a client agrees to before the first session, in plain language they can follow.
Download the Word version to edit it for your practice, or the counselling consent form PDF to see the layout. The wording works as a psychotherapy consent form too, and can be adapted for couples counselling and for children, where a parent or guardian signs.
Word (editable) and PDF · free · no sign-up needed
What’s inside
- Confidentiality and its limits
- Fees, payment and medical aid
- Cancellations and missed sessions
- Online sessions
- Record keeping and personal information
- Signature blocks for the client, and for a parent or guardian
This is a template, not legal advice, and it is not HPCSA approved. Have it reviewed against the HPCSA’s guidance and POPIA before you use it with clients.
Or skip the template
Send consent forms automatically when a client books
Clients complete and sign online, and their file creates itself with the signed PDF attached.
Guides that use this download
Counselling consent form: what it must cover in South Africa
What a counselling consent form in South Africa should cover: confidentiality, fees, online sessions, POPIA and consent for minors. Free template.
Online therapy in South Africa: HPCSA telehealth guidelines
The HPCSA telehealth guidelines explained for therapists: consent, confidentiality, records and how to run online therapy sessions in South Africa.
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