INFORMED CONSENT FORM

I, hereby grant permission for the professional therapist in charge to apply practices of Psychological Health Care Delivery, Consultation, Treatment, Referral to resources, Education, and the transfer of medical and clinical data.

Professional Relationship: The required relationship that a client/patient should have with the therapist is strictly professional. Any other relationship, such as business or personal relationships, that a client/patient may have with the therapist may hinder the effectiveness of the treatment. If you, as the client, feel that the working relationship between you and the therapist is changing or not conducive to your growth, you may terminate therapy sessions. If you wish to be referred to another mental health provider, the therapist may provide referrals.

Session Length: The number of sessions needed depends on the client's healing progress, which can be discussed with the therapist. Each session consists of a 1-hour duration, with an additional 15 minutes allotted in case of internet issues on either end. Sessions are conducted through Zoom, Google Meet for video calls, WhatsApp, or Viber for phone calls and chats. In the event of a disconnection, the therapist will attempt to contact the client through other means. Sessions must start on time, and if a client does not appear within 15 minutes, the session will be automatically forfeited, and fees will not be refunded.

Confidentiality: Sessions between the therapist and the client are strictly confidential. Any notes, audio recordings, or video recordings shall be kept confidential and secure by the therapist at all times and will not be disclosed to anyone without the client's prior written consent, except in cases of certain legal limitations such as child abuse, criminal acts, sexual abuse, HIV/AIDS transmission, or other instances where disclosure is required by law. If the therapist believes that the online therapy is no longer appropriate or the therapeutic relationship has changed, a referral may be made to another mental health provider within Solanna Psychological Services. The client also has the responsibility not to share the therapist's contact information.

Risks: Through therapy, clients learn more about themselves, including aspects they may not like. This self-awareness is a necessary step towards growth. Clients may experience emotional or physical distress during or after a session, which is a normal part of the healing process. The success of therapy depends on the efforts of both the therapist and the client. Clients should be aware of potential risks related to the transmission of personal information online and unauthorized access. Conversations between the psychologist and the client will be deleted after each session to minimize unauthorized access.

Advantages: Therapy helps clients open their awareness and gain personal insights to address
their problems. It can be challenging, especially for those who are hesitant to open up, but discomfort is a normal part of the process. With collaboration between the client and the therapist, progress can be faster than expected.

Limitations: In case of a mental health crisis and the therapist is unavailable, it is appropriate to call 911 or seek help from a hospital or crisis-oriented healthcare facilities. The therapist should not be contacted outside of office hours (9 am – 5:30 pm). For mental health crisis assistance, contact Solanna Psychological Services through their Facebook page or at 09359173561.

Payment:
Each session is scheduled for 1 hour, with a 15-minute leeway to account for potential internet issues.

Payment for the entire session is required in advance.

Payments can be sent to the Solanna Psychological Services Paymaya and Gcash account belonging to Japheth Maningding, with the phone number provided: 09359173561 or Philippine National Bank (PNB) account belonging to Japheth Maningding, with the account number provided: 209010248945

Scheduled sessions cannot be refunded, regardless of the reason, as it disrupt the therapist's scheduling.

If a session needs to be rescheduled, it cannot be refunded.

Court Proceedings: In the case of court proceedings involving the client, it is agreed that the therapist cannot testify, except in cases related to drug use where the junior therapist can assist with the proceeding.

Questions: For questions or concerns, you may contact the therapist at +63 9359173561 or through the Solanna Psychological Services Facebook Page.

Therapist: The therapist is a licensed psychologist and registered psychometrician with a graduate degree in MA in Psychology, specializing in talk therapy for individuals experiencing anxiety, mental health issues, and relationship challenges. Participation in therapy is voluntary, and clients may withdraw at any time upon notice.

I have read and understand the information above. My questions about the procedures and other matters have been answered to my satisfaction. I agree to participate in this therapy. I understand that by agreeing to participate, I have not given up any legal rights, and the therapist and the institution they represent are responsible for upholding all applicable laws.