Couples Counseling Consent Form
Couple Information
Partner 1 Name
Partner 2 Name
Partner 1 Email
Partner 2 Email
Date
Purpose of Counseling
Confidentiality & Agreement
We understand that information shared in counseling is confidential within legal and ethical limits.
We voluntarily consent to participate in couples counseling sessions.
We have been informed of the limitations of confidentiality (e.g., risk of harm, abuse reporting).
Additional Notes
Partner 1 Signature
Date
Partner 2 Signature
Date