Before We Begin

Therapy Intake & Consent Form

I, Ms. Janvi Parekh, Clinical Psychologist, warmly welcome you as you begin your journey with therapy. This form explains the nature of the psychological services you are about to receive and helps establish a transparent, mutually respectful therapeutic relationship. Please review the terms below carefully.

Sessions can be held in-person (Kandivali, Mumbai) or virtually over Google Meet, by prior appointment. You can view open slots and pick a time that suits you best.
View availability on Calendly

The Terms — please read before consenting

The therapist is committed to delivering compassionate and personalized care tailored to your unique needs, fostering a collaborative healing journey. There may be multiple interventions to effectively treat mental health concerns. As therapy progresses, the interventions may change but the process will be in line with the expressed concerns.
The relationship with a therapist is professional and therapeutic in nature. To preserve this relationship, it is imperative that the therapist does not have any other type of relationship with you. The therapist cares about helping you but is not in a position to be your friend or to have a social and personal relationship with you. Gifts, bartering, and trading services should not be shared between you and the therapist, as personal and/or business relationships undermine the effectiveness of the therapeutic relationship. In social circumstances where the therapist and client may encounter each other, the therapist will refrain from initiating any form of contact to protect the client's privacy and confidentiality. However, if the client initiates communication, the therapist may respond appropriately and professionally. If the client and therapist find themselves part of the same social or professional group, the therapist reserves the right to withdraw from the client–therapist relationship to maintain professional boundaries.
Kindly ensure that online sessions are attended in a private and undisturbed environment for the therapeutic process to be effective. Your responsibility is to actively participate by discussing the emotional, behavioral, interpersonal, or other distress you are experiencing. The therapist cannot be held responsible should any adverse events — such as lack of improvement, deterioration, or situations of potential risk of harm to self or others — occur during or after therapeutic intervention. The therapist may also temporarily stop, discontinue, or recommend another line of treatment if either party experiences difficulty in the process, in the client's best interest. If necessary, you may be referred to other professionals to ensure the most comprehensive and effective care.
• You may decline to proceed with any techniques the therapist may conduct. • You have the right to review your records from the therapist. • No information will be shared or revealed to any person, agency, or organization without your prior written consent, in accordance with the confidentiality policy. • You can raise any concerns and speak with the therapist to discuss matters. • You have the freedom to withdraw or terminate the therapeutic relationship at will, and may return to therapy anytime.
Sessions can be held in-person (Kandivali, Mumbai) or virtually via Google Meet, only with prior appointment. An online scheduling system is available so you can access the calendar and choose a time that suits you best.
There are typically 4 to 8 weekly (usually once a week) interactive one-on-one sessions, which may include regular homework assignments. Sessions are approximately 50 minutes in length. In case of extension, an extra 25% of the standard fees will be charged for every 15 minutes. The language of communication can be English, Hindi, and/or Gujarati.
To confirm a virtual appointment, fees for each session must be paid before the session begins. Failure to process payment 24 hours before the session's start time will result in automatic cancellation. In case of session extension, an extra 25% of the standard fees applies for every 15 minutes. Agreed fees remain the same for one year of the therapeutic alliance and are subject to annual revision. If agreed payments are not made, the therapist reserves the right to terminate therapy. Payments can be made via Paytm/GPay/NEFT and/or in cash during in-person sessions.
If you are late, the therapist will continue for the remainder of the scheduled time but cannot extend beyond the original end time, to avoid disrupting other clients. If you do not arrive within 15 minutes of the appointment time, the session will be declared concluded as a no-show. If the therapist anticipates being late, you will be notified in advance. If the therapist's delay affects the start time and both parties can stay longer, the full session time will be provided; otherwise, the remaining time will be adjusted in the following session.
At least 12 hours' notice is generally required to cancel or postpone a session without penalty. Sudden events such as emergencies may result in last-minute cancellations (within 4 hours of session time) or no-shows; in these cases, a 50% session fee will be charged, as reassigning the slot at short notice is impractical and may affect others waiting for an appointment. If the therapist must cancel due to unforeseen circumstances, the session will be rescheduled to another agreed-upon day and time.
The therapist is available for appointments as per open slots, except during personal holidays or illness. Any unavailability will be communicated within reasonable time, along with a rescheduled appointment. For a session missed due to the therapist's unavailability, no fee will be charged.
All interactions with therapy services — including scheduling, attendance, session content, progress, and records — are confidential and will not be shared without your knowledge. However, information may be shared where mandated or permitted: • If you or your child is deemed to pose a threat of harm to yourself or others, collaboration with police or a hospital may be necessary to prevent harm. • If events suggest a child under 18, or an elderly or disabled person, is at risk of emotional, physical, or sexual abuse, neglect, or exploitation. • If you are under 18, your parents or legal guardians may access your records and authorize release of information on your behalf. • If a court orders the release of information or a lawfully issued subpoena is received. • If cooperation is required for legal actions against a mental health professional by a licensing board.

Confirm & Submit

Once you've read the terms above, please complete the short form below to provide your consent and contact details.

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Before We Begin

Therapy Intake & Consent Form

I, Ms. Janvi Parekh, Clinical Psychologist, warmly welcome you as you begin your journey with therapy. This form explains the nature of the psychological services you are about to receive and helps establish a transparent, mutually respectful therapeutic relationship. Please review the terms below carefully.

Sessions can be held in-person (Kandivali, Mumbai) or virtually over Google Meet, by prior appointment. You can view open slots and pick a time that suits you best.
View availability on Calendly

The Terms — please read before consenting

The therapist is committed to delivering compassionate and personalized care tailored to your unique needs, fostering a collaborative healing journey. There may be multiple interventions to effectively treat mental health concerns. As therapy progresses, the interventions may change but the process will be in line with the expressed concerns.
The relationship with a therapist is professional and therapeutic in nature. To preserve this relationship, it is imperative that the therapist does not have any other type of relationship with you. The therapist cares about helping you but is not in a position to be your friend or to have a social and personal relationship with you. Gifts, bartering, and trading services should not be shared between you and the therapist, as personal and/or business relationships undermine the effectiveness of the therapeutic relationship. In social circumstances where the therapist and client may encounter each other, the therapist will refrain from initiating any form of contact to protect the client's privacy and confidentiality. However, if the client initiates communication, the therapist may respond appropriately and professionally. If the client and therapist find themselves part of the same social or professional group, the therapist reserves the right to withdraw from the client–therapist relationship to maintain professional boundaries.
Kindly ensure that online sessions are attended in a private and undisturbed environment for the therapeutic process to be effective. Your responsibility is to actively participate by discussing the emotional, behavioral, interpersonal, or other distress you are experiencing. The therapist cannot be held responsible should any adverse events — such as lack of improvement, deterioration, or situations of potential risk of harm to self or others — occur during or after therapeutic intervention. The therapist may also temporarily stop, discontinue, or recommend another line of treatment if either party experiences difficulty in the process, in the client's best interest. If necessary, you may be referred to other professionals to ensure the most comprehensive and effective care.
• You may decline to proceed with any techniques the therapist may conduct. • You have the right to review your records from the therapist. • No information will be shared or revealed to any person, agency, or organization without your prior written consent, in accordance with the confidentiality policy. • You can raise any concerns and speak with the therapist to discuss matters. • You have the freedom to withdraw or terminate the therapeutic relationship at will, and may return to therapy anytime.
Sessions can be held in-person (Kandivali, Mumbai) or virtually via Google Meet, only with prior appointment. An online scheduling system is available so you can access the calendar and choose a time that suits you best.
There are typically 4 to 8 weekly (usually once a week) interactive one-on-one sessions, which may include regular homework assignments. Sessions are approximately 50 minutes in length. In case of extension, an extra 25% of the standard fees will be charged for every 15 minutes. The language of communication can be English, Hindi, and/or Gujarati.
To confirm a virtual appointment, fees for each session must be paid before the session begins. Failure to process payment 24 hours before the session's start time will result in automatic cancellation. In case of session extension, an extra 25% of the standard fees applies for every 15 minutes. Agreed fees remain the same for one year of the therapeutic alliance and are subject to annual revision. If agreed payments are not made, the therapist reserves the right to terminate therapy. Payments can be made via Paytm/GPay/NEFT and/or in cash during in-person sessions.
If you are late, the therapist will continue for the remainder of the scheduled time but cannot extend beyond the original end time, to avoid disrupting other clients. If you do not arrive within 15 minutes of the appointment time, the session will be declared concluded as a no-show. If the therapist anticipates being late, you will be notified in advance. If the therapist's delay affects the start time and both parties can stay longer, the full session time will be provided; otherwise, the remaining time will be adjusted in the following session.
At least 12 hours' notice is generally required to cancel or postpone a session without penalty. Sudden events such as emergencies may result in last-minute cancellations (within 4 hours of session time) or no-shows; in these cases, a 50% session fee will be charged, as reassigning the slot at short notice is impractical and may affect others waiting for an appointment. If the therapist must cancel due to unforeseen circumstances, the session will be rescheduled to another agreed-upon day and time.
The therapist is available for appointments as per open slots, except during personal holidays or illness. Any unavailability will be communicated within reasonable time, along with a rescheduled appointment. For a session missed due to the therapist's unavailability, no fee will be charged.
All interactions with therapy services — including scheduling, attendance, session content, progress, and records — are confidential and will not be shared without your knowledge. However, information may be shared where mandated or permitted: • If you or your child is deemed to pose a threat of harm to yourself or others, collaboration with police or a hospital may be necessary to prevent harm. • If events suggest a child under 18, or an elderly or disabled person, is at risk of emotional, physical, or sexual abuse, neglect, or exploitation. • If you are under 18, your parents or legal guardians may access your records and authorize release of information on your behalf. • If a court orders the release of information or a lawfully issued subpoena is received. • If cooperation is required for legal actions against a mental health professional by a licensing board.

Confirm & Submit

Once you've read the terms above, please complete the short form below to provide your consent and contact details.

Loading secure form…

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