Muslim Faith Counseling Consent Form

Client Information

Full Name:

Date of Birth:

Phone Number:

Email Address:

This form provides consent for participation in faith-based counseling services guided by Islamic principles. Your participation is voluntary.

Your information will be kept confidential except where law requires disclosure.
Exceptions include risk of harm to self or others, abuse, or as required by law.

I have read and understood the information above.

I consent to participate in Muslim faith-based counseling.

Client Signature

Date

Counselor Signature

Date