Consent for Services: Counselworx™ operations are based within the State of Indiana and must therefore adhere to Indiana Sate Laws that govern counseling practices and services. Indiana requires that mental health providers obtain a signed consent for services prior to providing any such services. A parent or legal guardian must grant permission in order that any persons under the age of eighteen may receive counseling services.
Confirmation: I confirm that I am the legal, custodial parent or guardian of the minor child/teen under age eighteen named below. I give my permission for the psychological assessment and/or treatment by a Counselworx™ Counselor of this child. I understand that this permission will remain in effect during the duration of my child/teen's services with Counselworx™ or until revoked by me in writing.
Parental Confirmation and Consent to Counseling
Need to Share Your Child's Progress with Others?