Mental Health Confidentiality Agreement Template

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Video & audio overview of the template

What is the theory behind the template?

Confidentiality is a key element in any therapeutic process, however, there are times when this cannot be maintained and clients must be previously informed of these.

Clients also have a right to understand where documentation and records of their sessions will be stored and kept.

This will help build rapport and ensure that at the beginning of the intake process, the client is aware of these elements.

How will the template help?

This template provides a basic understanding of confidentiality and its limits. It allows the client to think of any questions surrounding this concept before the process begins. 

The template allows for official documentation of the client’s acknowledgment of this information.

How to use the template?

This template can be used as is, or it can be used as a guideline to tailor a confidentiality agreement form to your specific workplace.

Important to note: This is a template and as such is a general guide, it will need to be tailored to your specific practice and legal requirements.

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American Psychiatric Association. (2019). Protecting Your Privacy: Understanding Confidentiality in Psychotherapy.,that%20information%20leaving%20the%20room.