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FORM #3: INFORMED CONSENT FOR DYNAMIC PSYCHOTHERAPY AND PSYCHOTHERAPY CONSULTATION James Robin, Ph.D. Licensed Psychologist: PAY 22074 220 Newport Center Drive, Suite 1 Newport Beach, CA 92660 9493384388
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How to fill out informed consent for adults?

01
Begin by clearly identifying the purpose of the informed consent form. It should provide a concise and specific explanation of the procedure, treatment, or study that the adult is consenting to.
02
Include a section that outlines the risks and benefits associated with the procedure or treatment. It is important to list any potential complications or side effects, as well as the expected outcomes or improvements.
03
Provide a space for the adult to ask questions and seek clarification. This allows them to fully understand the information provided and make an informed decision.
04
Clearly state that participation is voluntary and outline any alternative options available. It is essential to emphasize that the adult has the right to refuse or withdraw their consent at any time without penalty or negative repercussions.
05
Include a section where the adult can indicate their agreement or disagreement with the informed consent. This can be in the form of a checkbox or a signature line.

Who needs informed consent for adults?

01
Informed consent is necessary for any medical procedure or treatment that involves an adult. It ensures that the individual understands the risks, benefits, and alternatives before making a decision.
02
Informed consent is also required for participation in research studies involving adults. This includes clinical trials, observational studies, and other types of research that involve human subjects.
03
In certain situations, such as when an adult lacks the capacity to give informed consent due to cognitive impairment or mental illness, a legal guardian or representative may provide consent on their behalf.
Remember, when filling out the informed consent form for adults, it is crucial to prioritize clear and comprehensive communication, respect the individual's autonomy, and ensure that they fully comprehend the information provided.
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