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Active Change Psychological Services, LLC 400 Jericho Turnpike, Suite 209 Jericho, New York 11753 LongIslandPsychologists@gmail.comINFORMED CONSENT TO GROUP PSYCHOTHERAPY This form documents that
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How to fill out intake informed consent form
01
Obtain the intake informed consent form from your organization or create one if it is not provided.
02
Clearly explain to the individual the purpose of the form and the information that will be collected.
03
Have the individual read through the form carefully and ask any questions they may have.
04
Ensure that the individual understands and consents to the information being collected and how it will be used.
05
Have the individual sign and date the form to indicate their informed consent.
06
Keep a copy of the completed form on file for your records.
Who needs intake informed consent form?
01
Anyone who is seeking services or treatment from a healthcare provider or organization may need to fill out an intake informed consent form.
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