This Treatment Consent describes the nature of psychotherapy services at Pasadena Clinical Group, your rights and responsibilities as a client, and the legal limits of confidentiality under California law. Please read carefully and discuss any questions with your clinician before signing.
1. Voluntary nature of treatment
Your participation in psychotherapy is entirely voluntary. You have the right to decline treatment and to terminate services at any time, for any reason, without prejudice or penalty. We encourage you to discuss your decision with your clinician so we can support a healthy ending or referral.
2. Risks and benefits of psychotherapy
Psychotherapy can produce significant benefits — improved relationships, reduced symptoms, greater self-understanding, and resolution of specific concerns. Therapy can also produce difficult feelings as part of the process: sadness, anger, anxiety, or memories of past experiences may surface temporarily. Most clients find these feelings manageable and meaningful, and your clinician will work with you to ensure the pace is appropriate.
Outcomes cannot be guaranteed. We use evidence-based approaches with strong research support, and we discuss progress openly throughout treatment.
3. Confidentiality and its limits under California law
Information you share with your clinician is generally confidential and protected under HIPAA, the California Confidentiality of Medical Information Act (CMIA, Cal. Civ. Code §56 et seq.), and Welfare & Institutions Code §5328. There are, however, specific exceptions where California law requires us to disclose information without your consent:
- Suspected child abuse or neglect — under the Child Abuse and Neglect Reporting Act (CANRA), Cal. Penal Code §11164 et seq., licensed mental health professionals are mandated reporters.
- Suspected elder or dependent adult abuse — under Cal. Welf. & Inst. Code §15630, we are mandated to report.
- Imminent danger to self or others — including the duty under Tarasoff v. Regents of the University of California and Cal. Civ. Code §43.92 to take protective action when a client communicates a serious threat of physical violence against a reasonably identifiable victim.
- Court orders — including subpoenas and judicial orders that compel disclosure (we will notify you when legally permitted and assert applicable privileges).
- Insurance / payment — we share the minimum information necessary with insurers for claims and authorization, as you authorize.
4. Records and your rights
You have the right under California Health & Safety Code §123100 et seq. to inspect and obtain copies of your treatment records, with limited exceptions (e.g., portions a clinician reasonably believes would cause substantial detrimental impact). You also have the right to request amendments to your record. Psychotherapy notes (process notes kept separately from your formal record) are afforded heightened protection under HIPAA and may not be disclosed without your specific authorization.
5. Records retention
California requires retention of healthcare records for at least seven (7) years following the last date of service for adult clients. For minors, records are retained until the minor reaches age 19, or seven years after the last date of service, whichever is longer. Records are stored securely and disposed of in compliance with HIPAA when retention periods expire.
6. Communication outside session
Email, text, and unencrypted phone communication are convenient but not secure. By providing these contact methods, you authorize their use for scheduling, billing, and brief check-ins, and you acknowledge the risks of unintended disclosure. We do not provide clinical care via email or text. For emergencies, please call 988 or 911.
7. Insurance authorization
If you use insurance, you authorize us to disclose Protected Health Information to your insurer for the purposes of payment and case authorization. This typically includes diagnostic codes, treatment dates, and limited treatment summaries.
8. Termination of services
You may terminate at any time. Your clinician may also recommend referral to a different provider or level of care if your needs exceed our scope, and will support a continuity-of-care transition. We do not terminate services for non-clinical reasons except for reasons of safety, repeated non-payment after good-faith resolution attempts, or abusive conduct toward staff.
9. Acknowledgment
By signing below (in person or electronically), you acknowledge that you have read this consent, had the opportunity to ask questions, and understand the nature of services. You will receive a copy for your records.