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Consent form for Art Therapy with an Adult
Consent is required before the Art Therapy intervention can commence.  Please complete the attached form below.  Thank you.
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I have been given written information on the Art Therapy process and issues of

• privacy and confidentiality • information sharing
• records access

and have discussed this with the Art Therapist. I understand the written and verbal information given by the Art Therapist.
 *
Required
I confirm that I, the client, give consent to start Art Therapy.  

E-signature and client’s name required below:
 *
Date:
Additional requests for permissions:

Please note that refusing any of the requests below will not affect your right to access treatment.

Occasionally, I may give talks and lectures to other professionals and students and illustrate these with clinical vignettes. Client’s identity is always anonymised. Please let me know if you agree for me to use our Art Therapy work and images to do this. You are free to withdraw consent at any time.

And

Occasionally, I may publish articles about my work in professional journals and illustrate these with clinical vignettes. Client’s identity is always anonymised but be aware that professional journals are published online and once published, cannot be retrieved. Please let me know if you agree for me to use our Art Therapy work and images to do this. You are free to withdraw consent at any time before publication.

I give consent for the Art Therapist to use anonymised content and artworks for professional lectures, articles and professional journals.
 *
Required
E-signature and name of client required: *
Date:
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