As a client of Aashray Mental Health and Counseling Center , your well-being is your therapist’s top priority. Therapy is a relationship that works, in part, because of clearly defined

rights and responsibilities held by each person. Your therapist will use his or her professional judgment to determine your appropriate course of therapy. This consent form helps to create the safety to take risks and the support to become empowered to change. This form is also intended to inform you about your rights as a patient, limitations to those rights, and your therapist’s corresponding responsibilities. The consent you provide herein will last the entire duration of your treatment unless you revoke or modify your consent in writing. Do not agree to the terms and conditions of this informed consent form unless you completely understand and agree to all aspects.