Sample informed consent form for resuming in-person services

Psychologists transitioning back to face-to-face services may wish to protect their practice through informed consent.

APA has created a sample informed consent form (DOC, 25KB) for psychologists who are returning to the office to provide face-to-face services with the lifting of “stay at home” restrictions. (Please see our article on important factors to consider before reopening your office for more information.)

This document contains important safety considerations to help minimize exposure to the coronavirus, including guidance published by the Centers for Disease Control and Prevention and the World Health Organization. It is not intended to be an exhaustive list of possible actions nor is it meant to encourage psychologists to resume face-to-face services before they feel comfortable doing so.

Since the state and local health authorities where you practice may have published additional guidance, you are encouraged to modify this template to fit the specific requirements of your community as well as to the needs of your practice and patients.

This document is designed to be used in addition to your normal informed consent and business practices form — not as a substitute. You should use your normal informed consent form with clients before initiating services to cover important information (e.g. your fees, billing and collection practices, limits to confidentiality) and use this template as an addendum when patients are returning to (or starting) in-person services.

You may also wish to consult with your malpractice insurer for additional content they may recommend.

Disclaimer: We prepared this document to provide information to psychologists in this rapidly changing landscape. Because the law, regulations, and related information continually change, you are encouraged to monitor local, state and federal officials and update this form as necessary to stay in compliance with their guidance. Please note the date stamp on this form. Please note this document does not constitute legal advice, as APA and APA Services do not and cannot provide legal advice to our members or state associations. The information in this form should not be used as a substitute for obtaining advice from an attorney in your state.