Consents Form

Welcome to Mental Health Services of SwastiVishwa Institute. This form contains the information regarding the process of counselling and therapy, confidentiality statement, payment process and cancellation policy of the Institute.

If you are seeking career counselling for a minor (below 18 years of age) please read Section E of the form also.

Please read the entire form and agree to the terms of service and click Submit.

Once you submit the form and make the payment for session your appointment for Case History Session will be confirmed.

A. About Career Counselling:

Counselling & Therapy varies depending on the personalities of the psychologist and patient, and the problems you hope to address. There are many different methods used to deal with those problems. Words counselling and therapy/counsellor and therapist are used interchangeably.

• About Online-counselling: Online-counselling refers to the online mode of counselling which would be done using the Video Conferencing applications like Zoom.
• Psychological Evaluations and Therapy: Where necessary we will provide psychological evaluations for the assessment and diagnosis.
• For the therapy to be most successful, you will have to work on action plans as discussed in the sessions.
• Possible limitations to care: I understand that counselling and therapy services are by appointment only and that these consultations are not suitable for help during a crisis or emergency.

B. Confidentiality:

• I understand that this audio/ video consultation is strictly confidential. I agree to use a secure line/connection for these consultations. I understand that my counsellor will record audio or video sessions only for educational purpose with my prior consent and will not share the proceedings of this consultation with any other individual or agency. However, with my consent, my counsellor could use it to have their work supervised or for training of professionals. Apart from this, the details of the consultation would be shared only with a court of law, if mandated.
• Copy of session notes and reports will be kept with the institute. The information will be kept completely confidential.
• I also undertake that the proceedings of these consultations are not to be recorded, shared or disseminated by me or my relatives / other contacts to any third person or through social media. However, despite safety measures taken, there are chances for breach in security in technology. In such instances, both client and counsellor will not hold the other responsible for the breach.
• If a patient is threatening serious bodily harm to another, counsellor may be required to take protective actions. These actions may include notifying the potential victim, contacting the police, or seeking hospitalization for the patient. If the patient threatens to harm himself/herself, counsellor may be obligated to seek hospitalization for him/her.
• We are an education provider. For educational purpose an intern could be accompanying a therapist during a session. Also, with your consent some sessions will be recorded only for educational purposes.

C. Payment & Billing:

• Consent expressed online will suffice for you to receive online counselling services. The timing and mode of payment will be discussed with you.
• The individual consultation charges are per person.
• Our fees are very competitive for the expertise of our therapists. Kindly do not bargain with the counsellor/therapist before or after the session
• If there are any difficulties in communication (technical) during the session, it will be terminated, and a new appointment will be scheduled for which you will not be charged if the session has not progressed beyond half an hour. In case it has progressed for half an hour you will be charged half.
• You have the freedom to withdraw from these sessions at any time you wish. Sometimes, the therapist may also temporarily stop or discontinue sessions or recommend any other method or line of treatment that is in your best interest.

D. Cancellation policy:

• You will pay the fees at least 48 hours in advance before every session and receive a receipt for every payment
• Refunds will not be made if you miss an appointment, but the session can be rescheduled with the therapist within 24 hours of the session for another session within two weeks of the original session. Any cancellations made thereafter without a strong reason will not be refunded or used towards credits for a rescheduled session
• If the therapist needs to reschedule a session you will not have to pay for the rescheduled session
• If there is any issue with therapy or schedule or process, please contact the coordinator or the centre on Phone 9529181790 and email psychservices@swastivishwa.com
• Serving our clients is our topmost priority. If there is a negative experience, you will bring it to the notice of the Centre, you will not post negative remarks about the therapist or the Centre on social media or mainstream media. Specific complaints can be communicated in written form to the Centre and the Centre will strive to resolve issues for the client
• Clients will maintain complete confidentiality about the sessions from their side. They will not post descriptions of the sessions on social media
• If there is an emergency, please call the emergency number or your closest hospital. At this time the Centre does not run emergency services.

E. For Parents Seeking Therapy for Minor (below 18 years of age):

• Psychological Evaluations and Therapy: We provide psychological evaluations for the assessment, and diagnosis of learning, psychological, and developmental disorders.
• By submitting this agreement, you are giving consent for your son/daughter to undergo a psychological evaluation and therapy. A full psychological evaluation is a comprehensive assessment of cognitive, educational, and social/emotional functioning.
• The information provided by a comprehensive evaluation can inform treatment planning and develop educational interventions that are tailored to your child.
• During the intake interview, we will discuss your concerns and we will gather relevant background information to help us develop a battery of tests to address your specific questions.
• We may also review prior records and communicate with other professionals involved in your child’s care.