Informed Consent for Mental Health Treatment of a Minor

Introduction

Florida law requires that a parent or legal guardian provide informed consent for a minor child (under age 18) to receive mental health counseling. This document outlines your rights and responsibilities, as well as the policies and practices of this office.

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Nature and Purpose of Counseling

The purpose of counseling is to support the child’s emotional, behavioral, and social development. Counseling may involve play, talk therapy, family sessions, or other evidence-based interventions. The goal is to help the child develop healthy coping skills, process experiences, and improve functioning at home, in school, and in relationships.

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Confidentiality

Your child’s privacy is important. Information shared in counseling is confidential and will not be disclosed without your consent, except as required by law, including:

1. Suspected abuse, neglect, or exploitation of a child, elder, or vulnerable adult.
2. If the child poses a danger to self or others.
3. When records are subpoenaed by a court of law.

Note: Minors also have a right to some degree of confidentiality. Counselors will use professional judgment in deciding what information to share with parents to protect the therapeutic process while ensuring safety.

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Florida Law Regarding Consent 

• A parent or legal guardian must provide consent for mental health treatment of a minor.
• In certain limited circumstances, a minor age 13 or older may request a brief course of outpatient crisis counseling (up to two visits of 45 minutes each) without parental consent. However, ongoing treatment requires parental/legal guardian authorization.
• In shared custody or high-conflict cases, this practice requires written consent from only one parent unless a court order specifies otherwise. 
• We will notify the other parent that the minor child is receiving services. 

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Participation of Parents/Guardians

Parents and guardians play an important role in the child’s progress. At times, sessions may involve family participation. Parents are expected to:

• Encourage the child’s attendance and participation.
• Support counseling goals outside of sessions.
• Respect the therapeutic space by avoiding pressuring the child to disclose session content.

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Professional Records

Counselors maintain clinical records of your sessions, which you have the right to review. Records are stored securely and released only with your written consent or as required by law. Any therapeutic notes taken regarding my situation will be held in strictest of confidences.  I understand that even if I waive confidentiality, therapy notes will not be provided to anyone, for any reason, unless there is a court order issued by a Judge. 

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Fees and Payment

• Standard session fees will be billed to my insurance or EAP. 
• Self-Pay fees will be billed, based on the clinician providing the services. 
• Payment is due at the time of service unless prior arrangements are made.
• Missed appointments not canceled with at least 24 hours’ notice may result in a late-cancellation fee of $95.00. I understand insurance does not cover this fee and I will be responsible for the fee. I will not initiate any charge backs with my bank, as I have been informed and notified in advance. 

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Telehealth Services for Minors

Counseling may occur via secure video platform. Parents/guardians are responsible for ensuring privacy and access to a quiet space for the child during telehealth sessions.

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Risks and Benefits

• Benefits: Children may learn coping skills, improve emotional regulation, and strengthen family relationships.
• Risks: Discussions may bring up uncomfortable emotions, cause temporary increases in distress, or highlight conflicts within the family.

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Emergencies

This office does not provide 24-hour crisis services. In case of emergency, please call 911 or go to the nearest emergency room. You may also contact the National Suicide Prevention Lifeline at 988.

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Additional Items

I am aware that animals may be used for therapeutic purposes at this office and I give my consent for an animal to be near me.  If this does not apply to me, I will discuss it with office staff.

I understand that there are cameras monitoring the office lobby and hallway, both audio and video.  This is the safety and well-being of all who enter the office. 

I am aware that I may receive a mental health diagnosis, in accordance with the current edition of the Diagnostic and Statistical Manual of Mental Disorders. 

The use of a virtual scribe may be used: and it generates necessary documentation for the clinician. This eliminates the need for manual notetaking, and ensures that the time with your clinician flows smoothly and without interruption. 

The documents produced by the scribe are derived from session recordings, which are not stored and are automatically deleted after processing. The scribe complies with HIPAA regulations, with all data encrypted both in transit and at rest.

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Consent

I am the parent/legal guardian of the minor named below. I have read and understood the information in this form and consent to my child’s participation in counseling under these terms.