Minor Client Counseling Agreement Form
Client Information
Minor's Full Name
Date of Birth
Parent/Guardian Name
Address
Contact Number
Email
Counseling Information
Counselor/Therapist Name
Practice/Clinic Name
Number of Sessions (if known)
Agreement & Consent
Agreement Terms
Confidentiality Terms
Parental/Guardian Consent Statement
Parent/Guardian Signature
Date
Counselor/Therapist Signature
Date