"I am responsible for my own well-being, my own happiness. The choices and decisions I make regarding my life directly influence the quality of my days."
Client Signature to Informed Agreement to Therapy
I have reviewed the information in this agreement
I understand and I am in agreement with the above stated conditions.
I may see my confidential record from art therapy sessions at any time for so long as it exists.
If I participate in group therapy, I pledge to keep artwork and discussions of others in my art therapy group(s) confidential.
I have received and understand Monica Gobournes’ Professional disclosure statement
All of my questions regarding this consent and art therapy have been fully answered to my satisfaction.
My signature below indicates that I understand and agree to the above statements.
Art Therapy Client name (print): _________________________
Signature: __________________________________
Date:
Witness/Guardian/Carer name (print): _________________________
Signature: __________________________________
Date:
Art Therapist name: MONICA GOBOURNE
Signature: _________________________________
Date:
