Informed Consent for Treatment

I, the Client, hereby authorize Andrea Cornell Marriage and Family Therapy, P.C. to provide psychotherapy for a period of time to be determined by mutual agreement. I understand that Andrea Cornell, LMFT is the Founder and Supervisor of the practice. I understand that my therapist is a Licensed Marriage and Family Therapist or Licensed Clinical Social Worker, and Andrea Cornell provides clinical support and consultation.

I understand that it is common to experience uncomfortable feelings in the course of therapy; these experiences are often part of a natural process and may help point the way to change.

Andrea Cornell Marriage and Family Therapy, P.C. checks messages regularly; however, they are not available by phone on a 24-hour basis. In case of an emergency, I understand that I may call the 911 for a psychiatric emergency.

I understand that full payment is due at the beginning of each session unless other arrangements are made.

I understand that I am free to terminate the therapy at any time, and that discussion of ending therapy over a few sessions is likely to be a process that is beneficial to me.

If necessary, I consent to using telemedicine (interactive audio-video communications) with my therapist as part of my psychotherapy.

For couples and families in therapy: If one member of the family or couple shares something with the therapist which is unknown to the other(s), it is acknowledged that such withheld information may radically undermine the potential of the therapeutic work. Therefore, Andrea Cornell Marriage and Family Therapy P.C. has a “no secrets policy.”

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