Psychotherapy is confidential , with the below stated exceptions
Suicide/Self-Harm – Depression is a common emotion expressed in therapy, but if a patient is
feeling hopeless enough to imply or disclose a plan for suicide; steps need to be taken to ensure
his/her safety. This would include attempts to inform the family or nearest emergency contact
as deemed by the therapist for the safety of the patient.
Vulnerable Adults and Children: Mental health professionals are required by law to report
stated or suspected abuse of a child or vulnerable adult to the appropriate social services
agencies and/or legal authorities. Another family member deemed “safe” by the therapist and
patient may also be informed.
Insurance Providers: Information requested includes descriptions of impairments, dates and
times of service , diagnosis , treatment plans and treatment progress, prognosis for
improvement , case notes or summaries.
I have read and understand the above stated limitations to confidentiality. I accept the
subsequent ramifications should there be a need to act on one of the above stated exceptions.
Other than the noted exceptions, if there are reasons to disclose m protected confidential
information I understand that I will be provided a Release of Information.
