Mental Health Counseling Waiver Form
Please read and complete this waiver form before beginning counseling sessions.
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
I acknowledge that mental health counseling involves discussing personal and sensitive topics, and I consent to participate voluntarily.
I understand that counseling sessions are confidential except as required by law.
I release the counselor and organization from any liability arising from counseling sessions.
Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: