Confidentiality Agreement

This Confidentiality Agreement (“Agreement”) is made between:

Patient Name Mental Health Professional Name Date

Confidentiality Terms

All information shared during sessions between the Patient and the Mental Health Professional will be kept strictly confidential and will not be disclosed to any third party unless required by law or with the Patient’s written consent. Exceptions may include risk of harm to self or others, court orders, or other legal requirements.

Acknowledgement

By signing below, both parties acknowledge and agree to the terms outlined in this Confidentiality Agreement.

Patient Signature Date

Mental Health Professional Signature Date