Informed Consent & Service Agreement

Please read and check each box to confirm your agreement:

Service Agreement: I am voluntarily seeking psychological counseling services from Swayamprakash Psychological Services. I understand therapy is a collaborative process and specific outcomes cannot be guaranteed.

Confidentiality & Limits: I understand that all session details and records are strictly confidential. Confidentiality may only be broken under the following circumstances:
1.Mandated reporting under Indian law (including POCSO Act obligations regarding child safety).
2.Clear and imminent risk of severe harm to self or others.
3.Official court order or legal summons.

Scheduling & Payment: Appointments are finalized only upon payment confirmation. Held slots will be released if payment is not completed within 30 minutes of scheduling.

Cancellation Policy: Notice for cancellation or rescheduling must be given at least 24 hours prior to the session. Cancellations made with less than 24 hours' notice or no-shows may incur full session charges.

Crisis & Emergency Disclaimer: I acknowledge that Swayamprakash Psychological Services does not provide 24/7 crisis intervention services. In case of an emergency, I agree to contact emergency services, visit the nearest hospital.

Accuracy of Information: I confirm that all details provided in this form are accurate to the best of my knowledge.