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Informed Consent & Contract
This document sets forth the terms and conditions governing the therapeutic relationship between the client and
the therapist. By signing or affirming this agreement, the client confirms having read, understood, and agreed to the
scope, responsibilities, and structure of therapy.
This agreement applies to both in-person and online sessions and is enforceable under the jurisdiction specified
herein.
1. Fees and Financial Terms
1.1 Fee Structure
The fee structure is communicated prior to the initial call and finalised during the introductory session. Fees are
reviewed annually and may be revised with prior notice.
1.2 Payment Terms
Clients residing in India may remit payment prior to or immediately following the session, as agreed. Clients outside
India are required to pay via mutually agreed platforms in the appropriate currency. Any transaction fees are the
responsibility of the client.
1.3 Cancellations and Rescheduling
Sessions cancelled with less than 24 hours’ notice are subject to full charges. Exceptions may be considered in the
case of medical emergencies or unavoidable circumstances, at the therapist’s discretion.
2. Confidentiality and Records
2.1 Confidentiality
All information shared during the course of therapy is strictly confidential and shall not be disclosed without the
client’s prior written consent, except as required under applicable laws or as outlined in the section “Limits to
Confidentiality.”
2.2 Clinical Records
The therapist maintains brief clinical notes solely for professional use. These records are securely stored and are
not available for client review.
2.3 Supervision
In adherence to ethical standards, anonymized session content may be discussed in professional supervision.
Identifying details will not be disclosed.
2.4 Audio/Video Recording
Sessions may be recorded only with the client’s explicit consent. Any recordings will be used solely for supervision
and will be permanently deleted following their intended use.
3. Limits to Confidentiality
Confidentiality may be breached, without prior consent, under the following legally and ethically mandated conditions:
- Imminent risk of serious harm to self or others
- Disclosure or reasonable suspicion of abuse or neglect of a child, dependent adult, or vulnerable person
- Credible threat of violence or intent to commit a criminal act
Receipt of a court order, subpoena, or other legal directive requiring disclosure - In cases of couple or family therapy, information disclosed individually may be relevant to joint sessions and
may be brought forth with prior discussion
Wherever feasible, the client will be informed prior to any such disclosure. However, this may not always be possible
in urgent or high-risk situations.
4. Scope of Practice and Medical Responsibility
4.1 Non-Substitution of Medical or Psychiatric Care
Psychotherapy does not replace medical, psychiatric, or pharmacological care. Clients are strongly encouraged to
seek or continue appropriate medical consultation when required.
4.2 Collaborative Care
If the client is undergoing concurrent medical or psychiatric treatment or is taking prescribed medication, this must
be disclosed. The therapist may, with the client’s consent, collaborate with other healthcare providers to support
coordinated care.
4.3 Referrals and Discontinuation
Should the therapist determine that the client’s needs exceed the scope of their professional competence, a referral
to an appropriate practitioner will be o:ered. Therapy may be discontinued when clinically or ethically indicated,
with reasonable notice and support for transition.
5. Legal and Emergency Considerations
5.1 Emergency Contact Information
Clients are required to provide two valid emergency contacts. These contacts may be used if there is a credible
concern for the client’s safety.
5.2 Crisis Support
The therapist does not provide emergency or crisis intervention services. In the event of a crisis, clients are advised
to contact local emergency medical or mental health services. A list of relevant resources may be provided upon
request.
5.3 Indemnity Clause
The client agrees to indemnify and hold the therapist harmless from any legal claims, liability, or damages resulting
from decisions, actions, or consequences arising during or after the course of therapy.
5.4 Jurisdiction
This agreement is governed by and shall be construed in accordance with the laws of Pune, Maharashtra, India,
irrespective of the client’s location.
6. Amendments and Consent
Any modifications to this agreement must be made in writing and mutually agreed upon by both parties.