⚠️ Template content. This document is a substantively complete template prepared for review. It must be reviewed and finalized by Pasadena Clinical Group's California-licensed healthcare attorney and compliance officer before publication.

On this page

1. Voluntary nature of treatment

Therapy is voluntary. You have the right to refuse treatment, to terminate at any time, and to ask any question about the process. We will explain why we recommend any particular approach, and you are free to decline.

2. Benefits and risks of psychotherapy

Benefits include reduced symptoms, increased self-understanding, improved relationships, and improved coping. Risks include experiencing uncomfortable feelings (sadness, anger, anxiety) as you work through difficult material; recalling distressing memories; periods during which symptoms may temporarily intensify; and changes in relationships as you change. Psychotherapy is not a guaranteed outcome; results vary by person, situation, and the work done.

3. Confidentiality and its mandatory exceptions under California law

What you say in session is confidential within the limits of California and federal law. We are required by law to break confidentiality in the following situations:

  • Suspected child abuse or neglect — California Child Abuse and Neglect Reporting Act (CANRA), Penal Code §11164 et seq.
  • Suspected elder or dependent adult abuse or neglect — Welfare & Institutions Code §15630.
  • Threats of serious physical violence against an identifiable victim — Tarasoff duty to warn or protect, Civil Code §43.92.
  • Imminent danger to self or others — including involuntary hold under Welfare & Institutions Code §5150 when criteria are met.
  • Court orders — when properly issued.

We may also disclose information when you sign a written authorization, when we consult a colleague (in a way that does not identify you), and as otherwise required by law.

4. Insurance and payment

If you use insurance, your insurance company may require disclosure of certain information about your treatment, including diagnosis, dates of service, and progress notes in some cases. You have the right to ask what information we will be disclosing. If you pay out of pocket and request that information not be disclosed to your insurer, we will honor that request to the extent permitted by law.

5. Communication outside of session

Email, text message, and voicemail are not fully secure forms of communication. By signing this consent, you authorize us to use these methods for scheduling and brief administrative messages. For clinical communication, we use a HIPAA-compliant client portal. Please do not include sensitive personal health information in unsecured communication.

6. Records and retention

We maintain a clinical record. You have the right to inspect and copy your record under California Health & Safety Code §123100 et seq. We retain adult records for at least seven (7) years from the last date of service. Records of minors are retained until the minor reaches age 19, or seven (7) years from the last date of service, whichever is longer.

7. Minors and consent

Minors aged 12 and over may consent to outpatient mental health treatment under California Family Code §6924, when the clinician reasonably determines the minor is mature enough to participate intelligently in the treatment and either (a) presents a danger of serious harm to self or others, or (b) has been the alleged victim of child abuse or neglect. We discuss with the minor and (where appropriate) the parent or guardian what information will be shared with the parent and what will remain confidential.

8. Termination of services

You have the right to end therapy at any time. We may also recommend termination if treatment is not benefiting you, if a different level of care is needed, or if other circumstances make continuing inappropriate. We will provide referrals when termination occurs.

9. Emergencies

We are not an emergency service. If you or someone you know is in crisis, call or text 988 or call 911. We will work with you on safety planning during regular sessions and will respond to non-emergency messages during business hours.

Questions or requests

For questions about this document or to exercise any of the rights described, contact us: