Therapy Consent Form Template for Netherlands

A comprehensive consent form designed for therapeutic services in the Netherlands, complying with Dutch healthcare legislation including the Medical Treatment Contracts Act (WGBO) and GDPR/AVG requirements. This document establishes the therapeutic relationship between mental health professionals and their clients, outlining treatment parameters, privacy policies, rights and responsibilities, and consent procedures. It incorporates specific Dutch legal requirements for informed consent in healthcare while ensuring clarity and accessibility for patients.

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What is a Therapy Consent Form?

The Therapy Consent Form serves as a crucial document in establishing and maintaining professional therapeutic relationships in the Netherlands. It is designed to comply with Dutch healthcare legislation, particularly the Medical Treatment Contracts Act (WGBO), the Healthcare Quality, Complaints and Disputes Act (Wkkgz), and data protection regulations (GDPR/AVG). This document should be used before commencing any therapeutic relationship to ensure informed consent, document agreement to treatment terms, and clarify both parties' rights and responsibilities. The form encompasses essential elements including treatment framework, privacy provisions, financial arrangements, and emergency procedures, while maintaining accessibility for clients. It's particularly important in mental healthcare settings where clear boundaries and expectations are crucial for therapeutic success.

What sections should be included in a Therapy Consent Form?

1. Parties: Identification of the therapist/practice and the client (and legal representatives if applicable)

2. Treatment Information: Description of the proposed therapy/treatment approach and its general purpose

3. Rights and Responsibilities: Overview of patient rights (including right to refuse treatment) and responsibilities of both parties

4. Confidentiality and Privacy: Information about confidentiality policies, privacy protection, and data handling in accordance with GDPR/AVG

5. Session Framework: Information about session duration, frequency, cancellation policies, and emergency procedures

6. Financial Arrangements: Information about fees, insurance, payment terms, and cancellation charges

7. Record Keeping: Information about how clinical records are maintained and accessed

8. Declaration of Consent: Formal consent statement and signature sections for all parties

What sections are optional to include in a Therapy Consent Form?

1. Telehealth Services: Include when offering online or remote therapy sessions, detailing specific procedures and requirements

2. Group Therapy Provisions: Include when offering group therapy, addressing specific confidentiality and group interaction guidelines

3. Minor Client Provisions: Include when treating minors, detailing parental involvement and consent requirements

4. Crisis Management: Include for treatments involving high-risk clients or specific mental health conditions

5. Research Participation: Include if clinical data might be used for research purposes

6. Multi-disciplinary Care: Include when treatment involves multiple healthcare providers or referral networks

What schedules should be included in a Therapy Consent Form?

1. Privacy Policy: Detailed privacy policy and data protection information in compliance with GDPR/AVG

2. Fee Schedule: Detailed breakdown of fees and payment terms

3. Practice Information: Practical information about the practice, including contact details, emergency numbers, and location

4. Patient Rights Document: Comprehensive overview of patient rights under Dutch healthcare law

5. Complaint Procedure: Detailed procedure for handling complaints as required by Wkkgz

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents

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And Informed Consent Form

A Dutch law-compliant informed consent form for medical research or treatment, meeting WMO and GDPR requirements.

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What is a Therapy Consent Form?

What sections should be included in a Therapy Consent Form?

What sections are optional to include in a Therapy Consent Form?

What schedules should be included in a Therapy Consent Form?

Authors

Alex Denne

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