Trauma-Informed Behavioral Health Consent Form
Client Information
Client Name
Date of Birth
Contact Information
Purpose of Consent
Services to Be Provided
Trauma-Informed Care Approach
Risks and Benefits
Confidentiality
Limits of Confidentiality
Voluntary Participation
Right to Withdraw
Questions & Concerns
Consent
I have read and understand the information provided above. I consent to receive trauma-informed behavioral health services.
Client Signature
Date
Provider Signature
Date