MindsetWellness and Healing
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Mindset Wellness and Healing

Client Consent & Service Agreement

Outpatient Counselling, Psychotherapy, Recovery Support & Wellness Services

Please read this document before your next appointment. It explains how we work together, what you can expect from us, and what we ask of you in return.

Before you begin Fields marked required need to be completed before you can submit. Use the section list to move through the agreement.

Client details

Welcome, services, rights, fees and confidentiality

1. Welcome & Introduction

Welcome to Mindset Wellness and Healing. We are glad you have chosen to begin this part of your journey with us.

This document explains, in plain language, what you can expect from us and what we ask of you in return. We are happy to answer any questions before you sign.

2. Our Services

Mindset Wellness and Healing offers a range of mental health, addiction recovery and wellness services, including:

  • Individual counselling and psychotherapy
  • Addiction and recovery support
  • Group therapy and group based recovery support
  • Wellness programmes, coaching and psychoeducation

Your therapist or counsellor will discuss which of these are appropriate for you. While we are committed to providing care that reflects current best practice, we cannot guarantee any specific outcome.

3. Your Rights & Responsibilities

Your Rights
  • To be treated with dignity, respect and without judgment
  • To receive clear information about your treatment, including its benefits and any reasonably foreseeable risks
  • To ask questions at any point in your care
  • To discontinue services at any time, understanding that your therapist may share clinical recommendations about doing so safely
Your Responsibilities
  • Honest and open participation in your sessions
  • Attending scheduled sessions, and informing us promptly if you are unable to attend
  • Taking an active role in planning and reviewing your treatment
  • Meeting your payment obligations as outlined below

4. Appointments, Cancellations & Fees

To help us provide consistent, high quality care to all our clients, the following practical guidelines apply:

  • Sessions are usually 50 to 60 minutes long, unless otherwise agreed with your therapist
  • We request at least 24 hours notice if you need to cancel or reschedule an appointment
  • Missed sessions, or cancellations made with less than 24 hours notice, may be charged the full session fee
  • Payment is due after each session, unless a different arrangement has been agreed in advance
  • Certain services, such as assessments or reports, may involve charges beyond the standard session fee
  • We will let you know in advance of any changes to our fees

5. Confidentiality

Confidentiality is central to effective therapy and recovery support. What you share with your therapist or counsellor will not generally be disclosed to anyone outside Mindset Wellness and Healing without your knowledge.

There are a few situations in which we may need to share information without your specific consent, in keeping with professional and legal requirements in India:

  • There is a serious risk to your own safety, including a risk of self harm or suicide
  • There is a serious risk of harm to another identifiable person
  • There is reasonable cause to believe a child or other vulnerable person is being abused or neglected
  • We receive a valid court order or other legal requirement to disclose information
  • A medical emergency requires relevant information to be shared with treating professionals
  • For routine clinical supervision or consultation with colleagues, with identifying details minimised wherever possible

In all such situations, we share only what is reasonably necessary, and will discuss this with you wherever possible.

Emergency contact, crisis and communication

6. Emergency Contact Information

Please provide details for someone we can reach if we believe it is necessary for your safety.

By providing these details, I authorise Mindset Wellness and Healing to contact this person when considered clinically necessary to protect my safety or wellbeing.

7. In Case of Crisis

If you are experiencing a crisis, such as a serious risk to your safety or a medical emergency, please do not wait for your next scheduled session.

In an Emergency
  • National Emergency Number: 112
  • Tele MANAS, the Government of India 24x7 mental health helpline: 14416 or 1800 89 14416
  • KIRAN Mental Health Helpline: 1800 599 0019
  • Your nearest hospital emergency department
  • Your emergency contact, as listed in Section 6

Mindset Wellness and Healing is an outpatient practice and does not provide 24 hour or on call emergency coverage. Phone calls, emails, SMS and WhatsApp messages are not monitored continuously and should not be used in an emergency.

8. Communication & Telehealth

We may use phone, email, SMS or WhatsApp to communicate with you about scheduling and routine updates. Please use these channels only for non urgent matters, and refer to Section 7 for emergencies. Where sessions are conducted online, we encourage you to join from a private, quiet space with a stable internet connection.

Consent & Signatures

By signing below, you confirm that:

Client and guardian sign-off

Sign below and submit. Your clinician will review and countersign your form afterwards, and a signed copy will be emailed to you.

Client

Thank you for trusting Mindset Wellness and Healing with your care. We look forward to working with you.

Changing Minds. Transforming Lives.

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