Informed Consent

Informed Consent for Therapy Agreement

Last Updated: January 17, 2026

Please read through the following informed consent agreement. What follows is a basic understanding between client and the therapist. In general, what is listed below are the responsibilities and obligations of your therapist, and also some expectations of you as the client. This document also contains important information about our professional services and business policies. Do not sign the informed consent unless you completely understand and agree to all aspects. If you have any questions, please bring this form back to your next session, so you and your therapist can go through this document in as much detail as is needed. When you sign this document, you will sign an agreement between us.

Psychotherapy

Voluntary Participation:

All clients voluntarily agree to treatment and accordingly may terminate at any time without penalty. Counseling involves a large commitment of time, money, and energy, so you should be thoughtful about the therapist you select. In the first couple of sessions, you should be deciding whether your therapist is right for you. If you feel it is not a good match, then your therapist will be happy to assist you in finding a new therapist.

Client Involvement:

All clients are expected to show up to appointments on time, be prepared to focus on and discuss therapy goals and issues, and will not attend while under the influence of mood-altering chemicals. All clients are expected to be open and honest so your therapist can assist you with your goals. Counseling calls for a very active effort on your part. In order for therapy to be successful, you are encouraged to work on things we talk about both during our sessions and at home. Inconsistent attendance can negatively affect your therapy progress.

Guarantees:

The majority of people do get better in therapy. Accordingly, your therapist makes no guarantee of results. It is not possible to guarantee results such as becoming happier, saving marriages, stopping drug abuse, becoming less depressed, and so forth.

Risks of Therapy:

Just as medications sometimes cause unexpected side effects, counselling can stimulate painful memories, unanticipated changes in your life, and uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. In some cases, the client’s symptoms become worse during the course of therapy, occasionally necessitating hospitalization. Another risk of therapy is that, throughout the process of therapeutic change, it is not uncommon for clients to reach a point of change where they may feel they are different and no longer able to be the same person they were upon entering therapy. At times, these feelings can be unsettling.

Benefits of Therapy:

The benefits of therapy can include: a higher level of functional coping, solutions to specific problems, new insights into self, more effective means of communicating in relationships, symptomatic relief, and improved self-esteem.

Confidentiality

Confidentiality and Privilege:

The information and content shared in therapy will remain confidential, except as noted in the next section: Exceptions to Confidentiality and Privilege. Your information will not be shared with anyone without your written consent. Your information is also privileged, which means that your therapist is free from the duty to speak in court about your counseling unless you waive that right or a judge orders it.

Medical/ Treatment Records:

In compliance with the Mental Health Act of India, patient records, including assessment reports and session summaries, will be retained for the legally mandated duration. Patients may request access to their medical records at any time with a week’s notice.

Exceptions to Confidentiality and Privilege:

Your therapist is legally obligated to breach confidentiality under the following circumstances:

Child Abuse (POCSO): When there is reason to suspect that a minor (under 18) is being abused or neglected.
Imminent Danger: If the client poses a serious and immediate threat to their own life (suicide) or the life of another person (homicide).
Court Orders: If a valid court order requires the release of records.

Confidentiality has limitations for minor clients. Parents and guardians have the legal right to access a minor client’s records.
- Minor clients do have the right to complete confidentiality in obtaining counseling for pregnancies and associated conditions, sexually transmitted diseases, and information about alcohol or drug abuse.

Therapist

Therapist Involvement:

Your therapist will be prepared at the designated time (barring emergencies), and will be attentive and supportive in meeting the therapy goals, and will do everything possible to assist you in achieving a greater sense of self-awareness and work toward helping you resolve problem areas.

Credentials and Qualifications:

Counselors at Synapse Mental Wellbeing hold a variety of degrees in the field of psychology such as Masters or Doctoral Degrees in Psychology, Family Therapy, and Psychiatry. Our Counselling Psychologists are registered with the National Commission for Allied and Healthcare Professions (NCAHP) and operate strictly within their authorized scope of practice."

Counseling Approach & Theory:

At Synapse, we believe that each individual is different and unique, and as such, do not limit ourselves to any 1 approach. Your therapist generally uses an eclectic therapy approach that includes a Cognitive-Behavioral and Humanistic orientation to counseling. Your counselor focuses largely on client responsibility in therapy, building a relationship with clients, creating a nurturing environment conducive to change, exploration of past events and how they continue to affect you today, analysis of underlying belief systems and their relation to inadequate functioning or hindrance to change, and implementation of specific emotional, cognitive, and behavioral techniques designed to aid in change toward specified goals.

Colleague Consultation, Supervision, and Peer Supervision:

In keeping with standards of practice, your therapist may consult with other mental health professionals regarding the care and management of cases. The purpose of this consultation is to ensure the quality of care. Your therapist will maintain complete confidentiality and protect your identity by not using real names or any identifying information.

Sessions Policy

Sessions:

Once we have agreed to work together, we will usually schedule one appointment every 1-2 weeks at a time we can agree upon. Therapy sessions typically warrant intervals of at least 5-7 days between sessions, and the frequency will be suggested by the therapist based on the client's needs and availability.

Length of Therapy:

The session length is typically 45 minutes. Occasionally, sessions may run as long as 55-60 minutes. Because our meetings are your time, you are expected to come to each session with a sense of what it is you would like to discuss or work on during that particular session.

The length of therapy is quite variable based on client motivation, the number and severity of issues to resolve, and work efforts outside of therapy sessions. On average, many people feel they have obtained what they were looking for in 10-25 sessions. For some, it is fewer, and for others, it may go longer.

Cancellation, No Show, or Late Arrival:

In general, all clients must provide the therapist with a minimum of 24 hours' notice in the event of a cancellation. Clients will be charged for appointments that are not cancelled at least 24 hours in advance and for all no-shows. A one-time emergency can be considered, and any emergencies will be decided on a case-by-case basis. Clients arriving late will not be provided with an extension of time beyond what they were scheduled so as not to disrupt other client appointments. No reduction in fees will result from shortened sessions due to a client’s late arrival.

Termination:

Either the client or the therapist may end therapy at any time. Your voluntary involvement allows you to discontinue at any time. If your therapist feels you are no longer benefiting from therapy or your therapist feels there is a conflict in values, they may discuss termination. If you desire additional counseling, your therapist will provide you with a referral competent to address your issues.

Synapse Policies

Contact:

Synapse does not provide the contact details for any individual therapists and encourages clients to contact the reception to direct any calls if needed.

Young Children in the Waiting Area:

We are not able to assume responsibility for the care of young children during therapy sessions. Having young children is generally disruptive to the counseling process, and we ask that you arrange for their care so you may come alone. If you have difficulty arranging child care elsewhere, please talk with your therapist. Children old enough to be responsible for themselves may wait in the reception area.

Custody Issues & Therapy for Minors:

It is the policy of Synapse Mental Wellbeing that for minor children, where legal custody is split (joint) between parents or guardians who are no longer married or cohabiting, we need authorization and a signature from both parents on our Informed Consent and Confidentiality Notice prior to the child being seen. These forms can be downloaded from our website and completed prior to arrival.

Ethical Guidelines:

Our clinical practice upholds the professional ethical standards established by the American Psychological Association (APA) to ensure global best practices in client care. However, as a mental health establishment based in India, we are legally bound by and strictly compliant with the Mental Healthcare Act 2017 (and any subsequent amendments) and the regulations of the National Commission for Allied and Healthcare Professions (NCAHP).

Note: While we strive to meet international ethical standards, in any instance where international guidelines differ from Indian statutory requirements, the laws of the Republic of India shall take precedence.

Medical Records:

The laws and standards of our profession require that we keep treatment records. You are entitled to receive a copy of the records unless we believe that seeing them would be emotionally damaging, in which case we will send them to a mental health professional of your choosing. Because these are professional records, they can be misinterpreted and/or upsetting to untrained readers. We recommend you review them in your therapist’s presence so we can discuss the contents. All client records include a data sheet filled out prior to therapy, a chronological listing of appointments and fees, a copy of signed releases, copies of any correspondence regarding your case, a copy of the signed informed consent packet materials, and a copy of all therapist notes. All records will be maintained by your therapist in a secure area for a period of time as prescribed by the Mental Health Act 2017 (and any subsequent amendments) or any such revisions, addendums, or additional acts which were recognised and published in the official channels at the start of service, from the time of service termination. As a client, you have a right to access your records. You also have a right to contest the material in your records, and it will be duly noted in your record. You do not have a right to alter your records or dictate information to be removed. You have the right to access and view your records, but you do not own the records, they are the property of Synapse Mental Wellbeing.

Counseling and Records for Minors:

Parental Rights vs. Privacy: Under Indian Law (including the Mental Healthcare Act, 2017), parents/legal guardians generally have the right to be informed about their child's diagnosis and treatment plan. However, effective therapy requires a trusting relationship where the minor feels safe to share details without fear of immediate disclosure.

Our Policy:

General Privacy: We request that parents agree to respect the privacy of the minor's specific session details. We will typically provide parents with general progress updates rather than detailed transcripts of sessions.

Safety Overrides:

Confidentiality will always be breached if there is a risk of:

Suicide or self-harm.

Harm to others.

Mandatory Reporting (POCSO):

Please be aware that under the POCSO Act, we are legally required to report any information regarding sexual abuse or sexual activity involving a minor to the relevant authorities, regardless of confidentiality promises. This includes cases of pregnancy in minors.

By signing this, parents acknowledge their legal rights but agree to limit their request for detailed records to support the therapeutic process, unless a safety concern arises.

Professional Fees:

Therapists may schedule diagnostic sessions at the start or when a need arises, which is more expensive. Follow-up therapy sessions are less expensive. Fees vary for other services provided such as testing or psychiatry. A fee schedule for services can be provided at your request.

Health Insurance:

You should be aware that most insurance companies require you to authorize us to provide them with a clinical diagnosis for benefits to pay for services. Sometimes we are required to provide additional clinical information such as treatment plans or summaries, or copies of the entire record (in rare cases). This information will become part of the insurance company's files and will probably be stored on a computer. Although all insurance companies claim to keep such information confidential, we have no control over what they do with it once it is in their hands. In some cases, they can share the information with national medical information databanks. It is important to remember that you always have the right to pay for services yourself to avoid the potential problems described above. Please keep us informed of changes in your financial status and insurance or medical assistance eligibility. You may be responsible for charges incurred if your coverage has changed or lapsed and you do not inform us in advance.

Phone Availability:

Your therapist may often not be immediately available by phone. Because of other obligations. Synapse may provide you with emergency supportive sessions with any other available Therapist.

Emergency & Interruption of Therapy:

In the event of any mental health or substance abuse emergency, we encourage you to contact the Synapse reception: or call 108. For immediate assistance.

Therapist’s Non-Availability:

When your therapists are on vacation or plan to be unavailable for a brief period of time, we will provide you with the name and number of another therapist you can contact with questions or come in to see as needed. In the event of a longer interruption of therapy, we will make appropriate referrals as needed.

Client Satisfaction Survey:

We welcome feedback about the services you receive. We are dedicated to improving the delivery of services to clients. Attached is a client satisfaction survey that you may fill out at any time during or after the completion of counseling.

Legal Terms

International Service Classification (For Non-Indian Residents)

If you are accessing our services from outside the Republic of India, you explicitly acknowledge and agree to the following:

Service Definition: The services provided to you are legally classified as "Mental Wellbeing Coaching & Consultation". These services are non-clinical in nature.
Non-Medical: These sessions focus on personal development, emotional regulation, and behavioral goals. They do not constitute a medical diagnosis, psychiatric treatment, or a substitute for local healthcare services.
Waiver: You agree that this professional relationship is governed exclusively by the laws of India and waive any right to pursue legal action in your local jurisdiction.

Dispute Resolution

Any dispute arising out of or in connection with this Informed Consent for Therapy Agreement, or the therapeutic relationship between you and Synapse Mental Wellbeing, shall be resolved through binding arbitration in Bengaluru, India, in accordance with the rules of the Indian Council of Arbitration.

Liability

Synapse Mental Wellbeing is not liable for any indirect, incidental, or consequential damages arising out of your use of our services or this Informed Consent for Therapy Agreement.

Governing Law and Jurisdiction

This Informed Consent for Therapy Agreement shall be governed by and construed in accordance with the laws of India. Any legal proceedings arising out of or in connection with this Agreement shall be brought exclusively in Bengaluru, India.

Arbitration

By signing this Informed Consent for Therapy Agreement, you agree to submit any dispute arising out of or in connection with this Agreement to binding arbitration in Bengaluru, India, as described above. You waive your right to a jury trial and to participate in any class action lawsuit.

Financial Agreement and Terms

Billing and Payments:

Please note that Synapse Mental Wellbeing typically operates on a direct-payment model. You are responsible for full payment of fees at the time of service. We will provide you with a compliant invoice which you may submit to your insurance provider for reimbursement, subject to your policy terms. We do not process "cashless" claims or direct "co-pays" unless explicitly stated otherwise.

Copays & Co-insurance:

Your signature below signifies your understanding and agreement to pay any copays at the beginning of your session on the date it is provided. If you are utilizing health plan benefits, you are responsible for any amount your insurance does not cover.

Cancellation, No Show, or Late Arrival:

In general, all clients must provide the therapist with a minimum of 24 hours' notice in the event of a cancellation. Clients will be charged for appointments that are not canceled at least 24 hours in advance and for all no-shows. Clients arriving late will not be provided with an extension of time beyond what they were scheduled so as not to disrupt other client appointments. No reduction in fees will result from shortened sessions due to a client’s late arrival.

Termination:

Additionally, if a client misses two appointments, your therapist has the option to terminate services and refer you to another clinic for services.

Refunds and Cancellations

No Refunds After Service Commencement:

Once therapy services have commenced, no refunds will be provided for any portion of the services rendered.

Cancellations and Terminations

If you need to cancel or terminate therapy services, please provide at least 24 hours' notice. Upon cancellation or termination, any unused portion of prepaid fees may be refunded, subject to the following terms and conditions:

Processing Fees: A processing fee will be deducted from any refund to cover administrative costs.

Refund Policy: Synapse Mental Wellbeing reserves the right to determine the amount of any refund and the process for obtaining it. Refunds will only cover services that have not yet been rendered.

Assessments and Reports

Purpose of Assessments:

The assessments, reports, and diagnoses conducted at Synapse are solely intended for internal therapeutic purposes. These evaluations serve as essential tools to formulate personalized treatment plans and interventions designed to support your healing process within our environment.

Non-therapeutic use of Assessments / Reports:

It is crucial to understand that the information obtained, including any diagnoses made, is not to be utilized outside the confines of Synapse for any non-therapeutic purposes, such as:

Legal proceedings: Should there be a requirement for information to be used in a legal capacity, we strongly advise seeking a separate forensic evaluation from a qualified professional. This additional evaluation is essential for any legal proceedings where psychiatric or mental health information is needed.
Benefits or leave requests: If you need to submit mental health-related information to avail benefits or leave requests, please consult with your therapist to discuss the most appropriate documentation and procedures. They may recommend obtaining a separate evaluation specifically tailored for these purposes.
Other non-therapeutic considerations: Any use of assessment information outside of therapeutic contexts should be discussed with your therapist to ensure it aligns with your best interests and legal requirements.
We encourage open communication with your healthcare provider at Synapse to ensure a comprehensive understanding of the limitations and appropriate use of the assessments, reports, and diagnoses conducted during your treatment. This proactive approach will help safeguard against any potential misunderstandings or legal implications.

Research

You may choose to participate in our Research Program.
Your personal health information will be anonymized, meaning your identity will be removed. This anonymized data will be used for research purposes only. It will help us measure the effectiveness and efficiency of our treatments and services. Additionally, anonymized data is often used in scientific research publications to share findings with the broader medical community.
You have the option to voluntarily consent to the use of your anonymized data for research purposes. You can withdraw your consent at any time, and we will ensure that your data is removed from our research database. Additionally, you can request that your data be redacted from any future publications.
Please note that once your anonymized data has been published or submitted for publication, it may not be possible to redact it. This is because published material is generally considered public information.
If you have any questions or concerns about our data privacy practices, please don't hesitate to ask.

Consent:

I have read and discussed the above information with my counselor.

I understand the risks and benefits of counseling and the nature and limits of confidentiality.

I have also been informed of helplines to which I can reach out in an emergency when my counselor is not available.

I understand the Privacy Policy.

I understand the Terms of Use.

I understand the Cancellation and Refund Policy.

I acknowledge that remote therapy has limitations regarding crisis management and technical privacy risks.

Signature of Client (Date) _____________________________

Signature of Counselor (Date) _____________________________

Acknowledgement for Online Clients:

If you are engaging with Synapse Mental Wellbeing via our digital platforms, you acknowledge that booking an appointment or making a payment constitutes your digital signature and explicit acceptance of this Informed Consent Agreement, the Privacy Policy, Cancellation and Refund Policy and the Terms of Use.

Other Policies

Informed Consent Form - (This form)

Cancellation and refund policy

Pro-Bono Policy

"Pay what you can" Program Policy

For any Queries Please feel free to reach out to us below

Get in touch so we can start understand how we can help you.

Informed Consent