Family Involvement Substance Abuse Treatment Consent

I hereby give my consent for the involvement of my family member(s) in my substance abuse treatment. I understand that family involvement may include participation in counseling sessions, treatment planning, and educational activities as part of my treatment process.

Client Information

Client Name Date of Birth

Family Member(s) Involved

Name(s) of Family Member(s)

Scope of Consent

I authorize the exchange of information between my treatment provider and the above-named family members for the purposes of treatment, support, and care planning. I understand that my participation and input are voluntary and that I can withdraw my consent at any time by providing written notice to my treatment provider.

Confidentiality

I have been informed of the confidentiality laws and regulations regarding substance abuse treatment records. I understand the limits of confidentiality and my rights regarding information sharing with family.