Informed Consent 

I authorize the verification of the information provided on this form to my best knowledge. • Any form of self-harming behavior is an emotional trauma for its survivor and their family. Every therapist tries to prevent this kind of behavior. In case, the client shows such self-harming behavior, Cognizavest or the therapist, or the counselor will not be liable for the same. Cognizavest LLP online counseling service is not an emergency service provider. If you have any emergency, you may take the help of emergency services and local resources available. . In case of any self-harm behavior or harm to others, the emergency contact of the family member had to be shared before continuing the therapy. • All the information collected will be kept confidential and will not be discussed anywhere. Though it has some exceptions which are:- • For more supervision and to get more insight your case might get discussed with a mental health professional but your personal identity will not be disclosed anywhere. • In case of a legal case, which is rare, when you are getting indulged in either harming yourself or any other person, then your identity will be shared with professionals in emergency services. • The administration will have your name and number for appointment scheduling

 “I accept that I am taking part in the counselling session with my own will. There has been no coercion that has been used to take me in the process. I have also read the important information above and accept the same. Emergency Services: I understand that Cognizavest LLP is not an emergency service and not liable for any injurious behavior which is harmful to me or others. Confidentiality: I have read the terms and conditions and I agree to share my information with the assigned psychologist/ counselor. And I understand that the expert suggestions for my case might get discussed with other mental health professionals but my identity will be kept confidential and my personal identity will not be revealed anywhere. I understand that there is a zero-tolerance policy against sexual and other forms of harassment and/or bullying. Any such conduct can lead to my removal from future sessions by Cognizavest and will be reported to the local authorities. *I understand the above statement: “

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