Informed Parental Consent for Therapy

Synapse Mental Wellbeing An Addendum to the Informed Consent for Therapy

Last Updated: June 28, 2026

Preamble

This Parental Consent Addendum ("Addendum") is a legally binding supplement to the Informed Consent for Therapy Agreement ("Primary Consent") published at https://www.synapsementalwellbeing.com/policies/consent-for-therapy. It governs the provision of therapeutic services to clients who are minors (persons under the age of 18 years) by Synapse Mental Wellbeing ("Synapse", "we", "us").

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The consenting parent or legal guardian ("Guardian") acknowledges that by signing or digitally accepting this Addendum, they enter into a complete and binding agreement with Synapse that incorporates, without limitation, each of the following policies as they may be amended from time to time:

• Informed Consent for Therapyhttps://www.synapsementalwellbeing.com/policies/consent-for-therapy

• Privacy Policyhttps://www.synapsementalwellbeing.com/policies/privacy

• Cancellation and Refund Policyhttps://www.synapsementalwellbeing.com/policies/cancellations-refunds

• Terms of Usehttps://www.synapsementalwellbeing.com/policies/termsofuse

• All Policies (master index)https://www.synapsementalwellbeing.com/policies

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The Guardian's obligations under all policies listed above are joint and several with those of the minor client to the extent permissible by law. The Guardian confirms they have read, understood, and unconditionally agree to each of the above documents in their entirety before signing this Addendum. Ignorance of any linked policy shall not constitute a defence against its enforcement.

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Where any provision of this Addendum conflicts with the Primary Consent or any linked policy, this Addendum shall prevail solely with respect to matters specific to minor client services. In all other respects, the Primary Consent and linked policies govern.

Section 1 — Definitions

For the purposes of this Addendum:

• "Minor" means the child named in the signature block below, being a person under 18 years of age.

• "Guardian" means the biological parent, adoptive parent, or court-appointed legal guardian who signs this Addendum.

• "Services" means all therapy sessions, psychological assessments, diagnostic consultations, and any ancillary services provided to the Minor by Synapse.

• "Clinical Records" means all session notes, progress summaries, assessment reports, diagnoses, correspondence, and any other documentation maintained by Synapse in relation to the Minor's treatment.

• "Co-Parent" means any other person who holds joint or shared parental rights or legal custody over the Minor.

Section 2 — Legal Authority to Consent

2.1 The Guardian warrants and represents that they are the lawful parent or court-appointed legal guardian of the Minor and hold the full legal authority to consent to healthcare and psychological treatment decisions on the Minor's behalf under the laws of the Republic of India, including the Mental Healthcare Act, 2017.

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2.2 The Guardian warrants that no court order, custody agreement, legal instrument, or other binding arrangement restricts, limits, or prohibits the Minor's participation in psychological therapy with Synapse.

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2.3 Joint or Shared Custody. Where legal custody is shared, held jointly, or otherwise divided between two or more persons, the signing Guardian further warrants that:

• (a) they have obtained the informed, prior consent of all Co-Parents or co-guardians holding parental rights before commencing Services; and

• (b) they have provided each Co-Parent with a copy of this Addendum and the Primary Consent for review.

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Synapse requires written confirmation of co-parental consent, which must be submitted prior to the commencement of the first session. Where both Co-Parents are required to sign under Synapse's custody policy (as stated in the Primary Consent), no Services shall commence until both signatures are received.

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2.4 Indemnification. The Guardian agrees to indemnify, defend, and hold Synapse Mental Wellbeing, its directors, clinicians, employees, contractors, and affiliates entirely harmless from and against any and all claims, disputes, legal proceedings, costs, damages, and liabilities of any nature arising from:

• (a) any failure to obtain co-parental or co-guardian consent;

• (b) any misrepresentation of legal authority to consent;

• (c) any breach of a custody agreement, court order, or parenting plan; or

• (d) any dispute between Co-Parents arising from or connected to the Minor's enrolment in Services.

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2.5 Synapse is not obligated to investigate, verify, or adjudicate custody disputes. Any conflict between Co-Parents regarding the Minor's participation in therapy shall be the sole responsibility of the Guardian to resolve. Synapse reserves the right to suspend or terminate Services without liability in the event of a notified custody dispute, pending written resolution acceptable to Synapse.

Section 3 — Risks and Benefits of Therapy for Minors

3.1 The Guardian acknowledges having read and understood the Risks of Therapy and Benefits of Therapy as set out in the Primary Consent. The Guardian confirms that these risks and benefits apply equally to the Minor's treatment.

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3.2 The Guardian specifically acknowledges that therapy may surface difficult emotions, past experiences, or behavioural changes in the Minor, and that these are a recognised and not uncommon part of the therapeutic process. Synapse assumes no liability for emotional, behavioural, or relational changes arising during or as a consequence of the therapeutic process.

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3.3 The Guardian acknowledges that Synapse makes no guarantee of therapeutic results for the Minor, as expressly stated in the Primary Consent.

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Section 4 — Confidentiality and the Therapeutic Alliance

4.1 The Guardian acknowledges that effective therapy with minor clients depends upon the establishment of a secure, trusting therapeutic relationship between the Minor and their clinician. To protect this alliance, the Guardian voluntarily agrees to the following confidentiality framework.

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4.2 As standard clinical practice, Synapse will provide the Guardian with:

• general progress updates and broad therapeutic themes;

• recommended strategies to support the Minor at home; and

• notification of any changes to the treatment plan that materially affect the Minor's care.

Synapse will not routinely provide the Guardian with detailed session transcripts, verbatim disclosures made by the Minor, or session-by-session clinical notes.

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4.3 The Guardian agrees to limit requests for detailed Clinical Records and session content in the interests of the Minor's therapeutic progress. This agreement does not extinguish the Guardian's legal rights to access the Minor's medical records under the Mental Healthcare Act, 2017. It constitutes a voluntary clinical cooperation arrangement in the Minor's best interests and may be revisited at the Guardian's written request.

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4.4 Minor's Statutory Confidentiality Rights. The Guardian acknowledges that under Indian law, including the Primary Consent and applicable clinical ethical standards, the Minor holds the right to complete confidentiality in relation to:

• counselling concerning pregnancy or associated conditions;

• sexually transmitted infections; and

• information relating to alcohol or substance use.

Synapse will not disclose such information to the Guardian except where required by law (see Section 5 below).

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4.5 Synapse assumes no liability for any outcome — therapeutic, relational, or otherwise — that the Guardian attributes to the operation of this confidentiality arrangement.

Section 5 — Mandatory Exceptions to Confidentiality

Confidentiality is not absolute. The Guardian is hereby placed on notice that Synapse's clinicians are legally and ethically obligated to breach confidentiality under the following circumstances. These obligations arise by operation of law and are independent of any contractual promise made by Synapse.

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5.1 Risk to Life. Where the clinician forms a reasonable professional opinion that the Minor is at imminent or serious risk of suicide, self-harm, or poses a credible threat of harm to another person, confidentiality will be breached immediately. The Guardian will be notified as soon as is clinically and operationally practicable. Synapse reserves the right to contact emergency services (including 108) without prior notice to the Guardian where immediate risk to life is assessed.

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5.2 Mandatory Reporting under the POCSO Act. Under the Protection of Children from Sexual Offences Act, 2012 ("POCSO Act"), all clinicians at Synapse are mandatory reporters by operation of law. The following disclosures must be reported to the relevant statutory and legal authorities, without exception and without prior notice to the Guardian:

• any disclosure of sexual abuse of a minor;

• any information indicating pregnancy in a minor; and

• any disclosure of sexual activity involving a minor in circumstances covered by the POCSO Act.

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This mandatory reporting obligation is absolute. It overrides all contractual, clinical, and ethical promises of confidentiality and cannot be waived by the Guardian or by Synapse. Synapse assumes no liability of any kind arising from compliance with this mandatory obligation. The Guardian acknowledges that such disclosure does not constitute a breach of any duty owed to the Guardian or the Minor.

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5.3 Court Orders. Synapse will comply with any valid order issued by a competent Indian court requiring the disclosure of the Minor's Clinical Records. The Guardian will be notified of such an order to the extent permitted by law.

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5.4 Peer Consultation. As disclosed in the Primary Consent, clinicians at Synapse may consult with other mental health professionals for the purposes of clinical supervision and quality of care. Such consultation is conducted without use of the Minor's identifying information and does not constitute a breach of confidentiality.

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5.5 Compliance by Synapse with any of the above obligations shall not entitle the Guardian to any claim, refund, or damages of any nature against Synapse.

Section 6 — Clinical Records and Data Governance

6.1 All Clinical Records pertaining to the Minor are the property of Synapse Mental Wellbeing, as stated in the Primary Consent. The Guardian and the Minor have the right to view records; they do not own them and may not alter, dictate the removal of content from, or direct the destruction of records.

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6.2 Retention. Clinical Records will be retained for the minimum period mandated by the Mental Healthcare Act, 2017 — typically 10 years from the date of last contact. Transactional and financial data relating to the Minor's treatment will be retained for 7 years for tax and audit compliance.

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6.3 AI-Assisted Documentation. The Guardian is hereby notified that Synapse utilises Fireflies.AI, a HIPAA-compliant automated transcription tool, to assist clinicians in maintaining accurate session notes. Sessions may be transcribed for this purpose. All AI-generated notes are reviewed and verified by the treating clinician. Fireflies.AI operates under a Business Associate Agreement (BAA) with Synapse. By signing this Addendum, the Guardian consents to this use of automated transcription for the Minor's sessions.

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6.4 Data and Privacy. The collection, storage, processing, and transfer of the Minor's personal and clinical data is governed by Synapse's Privacy Policy at https://www.synapsementalwellbeing.com/policies/privacy. The Guardian confirms they have read and accepted the Privacy Policy in full, including the provisions regarding:

• cross-border data transfer to service providers including Google Workspace, Wix, Fireflies.AI, and Microsoft Clarity;

• data retention timelines; and

• the Guardian's rights to access, rectify, and restrict processing of the Minor's personal data.

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6.5 Research. The Minor's anonymised data may be used for research purposes as described in the Primary Consent. The Guardian may opt out of this at any time by providing written notice to Synapse.

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6.6 Records Requests. Requests for Clinical Records must be submitted in writing with a minimum of 7 days' notice. Synapse reserves the right to determine the format and scope of records released, consistent with the clinical interests of the Minor and applicable law.

Section 7 — Financial Responsibility

7.1 The signing Guardian assumes sole and complete financial responsibility for all fees, charges, GST, and costs associated with the Minor's therapy, assessments, diagnostic sessions, and any other Services provided by Synapse.

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7.2 Full Policy Incorporation. All payment obligations, session fees, late cancellation charges, no-show fees, package terms, and refund entitlements are governed exclusively by the Cancellation and Refund Policy at https://www.synapsementalwellbeing.com/policies/cancellations-refunds. The Guardian confirms they have read and accepted that policy in full. Key terms include:

• 24-Hour Cancellation Notice: Cancellations or rescheduling requests must be made at least 24 hours prior to the scheduled session start time to avoid charges.

• Late Cancellations and No-Shows: Sessions cancelled with less than 24 hours' notice, or not attended without notice, will be charged at 100% of the applicable session fee. No credit or refund will be issued.

• Emergency Exception: A one-time waiver for a genuine emergency may be granted at Synapse's sole discretion. This waiver permits rescheduling only; it does not entitle the Guardian to a monetary refund. Any session rescheduled under this exception is strictly non-refundable.

• Packages and Bundles: Refunds for unused prepaid sessions are calculated at the standard single-session rate (not the discounted package rate), less a 5% administrative processing fee (minimum ₹500).

• Refund Timeline: Approved refunds are processed within 7–10 business days to the original payment source only. Cash refunds are not issued.

• Post-Commencement: Once a session has commenced, no refund is available for that session.

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7.3 The Guardian's financial obligations are not contingent upon their satisfaction with the therapeutic outcome or with any clinical or administrative decision made by Synapse.

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7.4 Insurance. Synapse operates on a direct-payment model. The Guardian is responsible for full payment at the time of service. Synapse will issue a compliant GST invoice which the Guardian may submit independently to their insurance provider. Synapse does not process cashless claims or direct co-pays unless explicitly agreed in writing.

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7.5 Missed Sessions Due to Termination. If the therapeutic relationship is terminated by Synapse due to two or more missed appointments (as provided in the Primary Consent), any outstanding fees remain payable in full.

Section 8 — Assessments and Reports

8.1 Any psychological assessments, diagnostic evaluations, or reports conducted in relation to the Minor at Synapse are for internal therapeutic purposes only. They are not intended for use in legal proceedings, insurance claims, school admissions, benefit applications, or any other non-therapeutic purpose.

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8.2 The Guardian acknowledges that Synapse's assessments and reports are explicitly not forensic evaluations. Should assessment information be required for any legal, administrative, or external purpose, the Guardian must obtain a separate specialist evaluation from a qualified professional. Synapse assumes no liability for any reliance on its clinical assessments outside of the therapeutic context.

Section 9 — Termination of Services

9.1 Either the Guardian (on behalf of the Minor) or Synapse may terminate Services at any time, consistent with the termination provisions in the Primary Consent.

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9.2 Synapse reserves the right to terminate Services and refer the Minor to another provider if:

• two or more sessions are missed without adequate notice;

• a custody dispute is notified that prevents Synapse from operating without legal risk;

• the Guardian or Minor engages in conduct that is abusive, threatening, or disruptive to Synapse's clinicians or operations; or

• continued provision of Services is, in Synapse's clinical judgment, no longer in the Minor's best interests.

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9.3 Upon termination, Synapse will, where clinically appropriate, provide the Guardian with a referral to another suitable provider.

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9.4 Outstanding fees for sessions attended or late-cancelled prior to termination remain payable in full regardless of the reason for termination.

Section 10 — Conduct and Terms of Use

10.1 The Guardian confirms they have read and accepted Synapse's Terms of Use at https://www.synapsementalwellbeing.com/policies/termsofuse in full.

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10.2 The Guardian agrees not to:

• record any session, whether audio or video, without the prior written consent of Synapse and the treating clinician;

• share, publish, or distribute any communications received from Synapse in any format without prior written consent;

• make defamatory, misleading, or damaging statements about Synapse, its clinicians, or employees in any public forum; or

• use any content, tools, or resources from Synapse's website for commercial purposes without prior written consent.

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10.3 Synapse reserves the right to remove or respond to any review or public statement made by the Guardian that is defamatory, false, or in violation of the Terms of Use.

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Section 11 — Limitation of Liability and No Guarantee

11.1 Synapse Mental Wellbeing, its directors, clinicians, employees, contractors, and affiliates shall not be liable — whether in contract, tort, or otherwise — for any direct, indirect, incidental, consequential, special, or exemplary damages arising from or in connection with:

• the provision of, or any outcome of, therapeutic Services to the Minor;

• disclosures made by the Minor during sessions;

• any mandatory reporting action taken by a clinician in fulfilment of their legal obligations;

• any clinical decision made in the lawful exercise of professional duties;

• any interruption, suspension, or termination of Services;

• cross-border data transfer or processing by authorised third-party service providers; or

• any reliance by the Guardian or any third party on Synapse's clinical assessments outside their intended therapeutic context.

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11.2 Synapse makes no representation, warranty, or guarantee - express or implied- that therapy will produce any particular outcome for the Minor.

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11.3 To the maximum extent permitted by Indian law, Synapse's total aggregate liability to the Guardian in respect of any claim shall not exceed the total fees paid by the Guardian for the Minor's Services in the three calendar months immediately preceding the event giving rise to the claim.

Section 12 — Governing Law, Dispute Resolution, and Jurisdiction

12.1 This Addendum shall be governed by and construed in accordance with the laws of the Republic of India. The Mental Healthcare Act, 2017, the POCSO Act, 2012, and the regulations of the National Commission for Allied and Healthcare Professions (NCAHP) apply where relevant.

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12.2 Any dispute arising out of or in connection with this Addendum or the therapeutic relationship between the Guardian and Synapse shall be referred to and finally resolved by binding arbitration in Bengaluru, India, in accordance with the rules of the Indian Council of Arbitration. The language of arbitration shall be English.

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12.3 The Guardian waives any right to participate in a class action, collective proceeding, or jury trial in connection with any such dispute.

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12.4 Any legal proceedings not subject to arbitration shall be brought exclusively before the competent courts in Bengaluru, Karnataka, India.

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Section 13 — Amendment, Severability, and Entire Agreement

13.1 Synapse reserves the right to amend this Addendum and any linked policy at any time. Amendments will be effective upon publication on Synapse's website. Continued use of Services following notice of any amendment constitutes the Guardian's acceptance of the revised terms.

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13.2 If any provision of this Addendum is found to be invalid, unlawful, or unenforceable under applicable law, that provision shall be severed, and the remaining provisions shall continue in full force and effect.

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13.3 This Addendum, together with the Primary Consent and all policies incorporated by reference in the Preamble, constitutes the entire agreement between the Guardian and Synapse with respect to the Minor's therapy services and supersedes all prior representations, communications, and agreements relating to that subject matter.

Declarations and Agreement

By signing or digitally accepting this Addendum, the Guardian explicitly declares and irrevocably agrees as follows:

1. Legal Authority and Custody. I am the lawful parent or court-appointed legal guardian of the Minor named below. I hold the legal right to consent to their psychological treatment. Where custody is shared, I have obtained the informed consent of all Co-Parents and provided them with copies of this Addendum and the Primary Consent. I agree to indemnify Synapse fully against any dispute, claim, or liability arising from my failure to do so.

2. Full Policy Agreement. I understand that the Unified Policy Statement, Informed Consent for Therapy (as applicable), Informed Consent for Psychiatry (as applicable), Parental Consent (if applicable), Privacy Policy, Cancellations and Refunds, Terms of Use, Pro-Bono Policy, and the "Pay what you can" Program Policy, along with any other policies published on our website, collectively form the entire agreement between you and Synapse Mental Wellbeing. These combined documents supersede all prior or contemporaneous communications, representations, or agreements, whether oral or written, relating to the subject matter herein.

3. Risks, Benefits, and No Guarantee. I understand and accept the risks and benefits of therapy as disclosed, and acknowledge that Synapse makes no guarantee of therapeutic results.

4. Confidentiality Arrangement. I agree to receive general progress updates rather than detailed session notes, and I agree to limit requests for Clinical Records in the interests of the Minor's therapeutic alliance, without prejudice to my legal rights under the Mental Healthcare Act, 2017.

5. Safety Overrides. I understand that confidentiality will be breached, and I will be notified, where the Minor is at risk of suicide, serious self-harm, or harm to others. I understand Synapse may contact emergency services directly without prior notice to me where immediate risk to life is assessed.

6. Mandatory Reporting (POCSO Act). I acknowledge and accept that Synapse's clinicians are mandatory reporters under the POCSO Act, 2012. Any disclosure relating to the sexual abuse of the Minor, or information indicating the Minor's pregnancy, must be reported to statutory authorities by law, without exception and without prior notice to me. I accept that this does not constitute a breach of any duty owed to me or the Minor.

7. Financial Responsibility. I accept sole financial responsibility for all fees and charges associated with the Minor's Services, including late cancellation fees, no-show charges, and package refund calculations as governed by the Cancellation and Refund Policy.

8. AI-Assisted Transcription. I consent to the use of Fireflies.AI for automated session transcription as disclosed in the Privacy Policy and Section 6.3 of this Addendum.

9. Limitation of Liability. I acknowledge that Synapse assumes no liability for therapeutic outcomes, mandatory reporting actions, clinical decisions, or data transfers made in the lawful exercise of its duties, and I agree to the limitation of liability set out in Section 11.

10. Child Assent. I confirm that I have explained the nature of therapy, the limits of confidentiality, and the mandatory reporting obligations to the Minor in a manner appropriate to their age and developmental stage.

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Minor Client's Full Name: _______________________________________________

Date of Birth of Minor: _______________________________________________

Parent / Guardian Full Legal Name: _______________________________________________

Relationship to Minor: _______________________________________________

Digital Signature / Typed Name: _______________________________________________

Date: [Auto-generated timestamp]

This Addendum forms part of the complete binding agreement between the Guardian and Synapse Mental Wellbeing. All referenced policies are available at https://www.synapsementalwellbeing.com/policies. If you have any questions regarding this Addendum prior to signing, please contact us at hello@synapsementalwellbeing.com or +91 91488 05435 before proceeding.