Client’s Informed Consent Form
(for clients 18 years or older)
Thank you for choosing Sawa Health. This informed consent form is intended for clients who are 18 years or older. It provides essential information about our therapy services, your rights as a client, and our mutual responsibilities. Please read carefully to ensure you understand and agree with the terms before starting your therapy journey. Our goal is to support your well-being in a safe, respectful, and collaborative environment.
Nature of Psychotherapy
Psychotherapy is a psychological treatment using various techniques to help you:
Understand the root causes of your problems
Gain insight into how these issues affect your daily life
Develop healthier coping strategies to improve overall well-being
Your Rights:
As a client, you have the right to:
Be treated with respect and dignity.
Inquire about your psychotherapist's qualifications.
Understand your diagnosis, treatment plan, and progress.
Participate in treatment decisions and refuse methods you’re uncomfortable with.
Expect privacy and confidentiality.
End therapy or request a referral at any time.
Change your therapist anytime if you feel uncomfortable.
Your Responsibilities:
To make therapy effective, you agree to:
Actively participate by being honest and completing agreed-upon assignments.
Attend scheduled appointments on time.
Inform your therapist of any major life changes.
Treat your therapist with respect and dignity.
Confidentiality and Privacy:
All patient records are securely stored to ensure privacy and confidentiality.
Sessions are never recorded.
We kindly request that you do not record or save any videos or voice recordings of the sessions.
In a crisis or life-threatening emergency (harm to self or to others), your psychotherapist may contact your emergency contact or the appropriate authorities.
Communication with family members: Any contact with a family member will only be done after your approval.
Therapy Process and Associated Risks:
Psychotherapy is a non-linear process. Discussing unpleasant feelings or experiences might initially cause discomfort. However, these short-term risks usually subside as you develop coping skills and begin feeling better. Your therapist will work with you to the best of their abilities to make sure to end the session with the least amount of discomfort.
Session Duration:
Session Time:
Individual sessions: each session lasts 45 minutes
Couple therapy sessions: each session lasts 60 minutes
Wait Time: Your therapist will wait 20-25 minutes in session if you have not given any prior notice of cancellation or rescheduling. If you do not show up within this time, the session will be canceled but counted as a paid session.
Delays: Any delay in attendance will cause your session time to be shorter. For example, if you join 10 minutes late, your time in session will be 35 minutes.
The total number of sessions depends on your needs and the treatment plan agreed upon with your psychotherapist.
Appointments & Attendance:
Cancellations: Notify your therapist at least 48 hours in advance to avoid being charged.
Rescheduling: If you inform the therapist with adequate time (48 hours in advance), your session can be rescheduled during the same day or week, according to availability. If you request a last-minute rescheduling, your session will be rescheduled in the week after if there are no available sessions during the same week. You are allowed to reschedule 2 times in a row, a 3rd rescheduling is considered a fixed & paid session.
Late Arrivals: You will be seen for the remaining time of your 45-minute session.
Contact: Therapists & counselors are accessible via Sawa email during office hours (Monday to Friday, 9:00 am - 6:00 pm Beirut time). You can also contact your counselor through email or the WhatsApp number shared with you. A reply will be sent within 24-48 hours.
Feedback Mechanism:
Feedback Form: An anonymous feedback form is available for you to fill at your convenience. The form can be used to provide your input, opinions or any concerns or suggestions you may have. You can find the link below and it is also available in the appointment reminder email sent before your session.
• Link: https://forms.gle/sfieyCD8JUe2SrBw5
Email and Whatsapp: You can reach out to your therapist with any questions, concerns or thoughts at anytime via e-mail and with your counselor via e-mail or whatsapp
Evaluation Form: An evaluation form will be sent to you after your first consultation with your counselor. After that, it will be sent again every 8 weeks as a way of collecting your feedback and tracking your progress.
Emergency Support:
For emergencies outside of therapy sessions, please contact the National Lifeline for emotional support and suicide prevention:
In Lebanon: 1564
Outside Lebanon: +961-1341941
Or according to the services available in the country you reside in: https://blog.opencounseling.com/suicide-hotlines/
Subscription and Payments:
Subscriptions: Sawa’s packages are automatically renewed depending on the number of sessions; we send payment reminders 3 days before the billing cycle to your registered email address.
Cancellations: You can cancel your subscription at any time, please make sure to message your counselor before the renewal. Any remaining sessions will remain in your credit for up to 3 months or can be transferred to another family member or friend if you decide not to continue therapy.
Pauses: Sessions can be paused for up to 3 months, and they will remain in credit.
Non-refundable: Packages paid on Sawa are non-refundable.
Payment Methods: Card, PayPal, Western Union, Whish Money, or Bank Transfer. Note: An additional 3% fee applies to any non-card payment options like PayPal, Western Union, and Bank Transfer payments.
Proof of Payment and Invoices: Available upon request from the counselor or Sawa’s support team (hello@sawa.health or via WhatsApp).
Client Acknowledgment:
I have read and understood this informed consent form.
I agree to the terms and conditions outlined above.
My consent becomes effective as soon as I subscribe to or use any service provided by Sawa Health.
Sawa Health
Assent Form
(for clients younger than 18 years)
Hi and thank you for joining Sawa Health!
We’re happy to have you with us for therapy. Here’s what you need to know:
What Therapy Is: Therapy is a safe space where you can talk about your thoughts and feelings. It helps you understand yourself better and figure out ways to feel better.
Your Choice: You don’t have to come to therapy if you don’t want to, and you can always ask questions or take a break if needed.
Privacy: What we talk about in therapy stays private and will only be shared with your parents after letting you know. If needed, we will share important information that will keep you or someone else safe from harm. We’ll explain this more in our sessions.
Your Rights: You can share how you feel about therapy, ask questions, and tell us if something makes you uncomfortable.
Your Role: Therapy works best when you talk openly and share your thoughts, even if it feels hard sometimes. It is also important that you attend each session on time.
If you start therapy with us, that means you have agreed to the above information.
We’re here to help you and make this a good experience for you!
Sawa Health Parent Consent Form
(for parents whose children are attending sessions at Sawa)
Thank you for choosing Sawa Health to support your child’s therapy journey. This consent form outlines your rights and responsibilities as parents or caregivers, and our role as Sawa Health in providing mental health services to your child. Please read carefully to ensure you understand and agree with the terms before your child starts therapy.
Purpose of Therapy
Therapy is a psychological treatment aimed at helping children understand their emotions, thoughts, and behaviors while developing healthy coping strategies. The goals and structure of therapy will be tailored to your child’s needs and discussed as needed.
Parent/Guardian Rights and Responsibilities
You have the right to inquire about your child’s treatment plan, progress, and the qualifications of their therapist.
You have the responsibility to:
• Ensure your child attends scheduled sessions on time.
• Support your child’s therapeutic process at home by reinforcing positive coping skills.
• Provide accurate and honest information during the initial intake session and as requested throughout therapy.
Confidentiality and Privacy
All patient records are securely stored to ensure privacy and confidentiality.
Sessions are never recorded.
We kindly request that you do not record or save any videos or voice recordings of the sessions.
Your child’s privacy is a priority. However, as the parent/guardian, you may receive general updates about your child’s progress. Specific details from sessions will remain confidential unless:
There is a risk of harm to your child or others.
Reporting is required by law (e.g., suspected abuse or neglect).
Your child agrees to share specific information.
Involvement in Therapy
As a parent, you may be invited to participate in sessions when necessary or requested by your child or their therapist.
Parental involvement is designed to support the therapeutic process.
You may request to attend a session, but this will only be approved if the therapist deems it necessary or important and after your child has agreed to your participation.
Emergency Support:
In case of an emergency, your child’s therapist may contact you or the appropriate authorities.
For emergencies outside of therapy sessions, you can contact the National Lifeline for emotional support and suicide prevention:
In Lebanon: 1564
Outside Lebanon: +961-1341941
Or according to the services available in the country you reside in: https://blog.opencounseling.com/suicide-hotlines/
Session Duration:
Session Time: each session lasts 45 minutes.
Wait Time: The therapist will wait 20-25 minutes in session if prior notice of cancellation or rescheduling has not been given. If your child does not show up within this time, the session will be canceled but counted as a paid session.
Delays: Any delay in attendance will cause the session time to be shorter. For example, if your child joins 10 minutes late, their time in session will be 35 minutes.
The total number of sessions depends on your child’s needs and the treatment plan that their psychotherapist is working on.
Appointments & Attendance:
Cancellations: Notify the therapist at least 48 hours in advance to avoid being charged.
Rescheduling: If the therapist is informed with adequate time (48 hours in advance), the session can be rescheduled during the same day or week, according to availability. If the request is a last-minute rescheduling, the session will be rescheduled in the week after if there are no available sessions during the same week. You are allowed to reschedule 2 times in a row, a 3rd rescheduling is considered a fixed & paid session.
Late Arrivals: Your child will be seen for the remaining time of their 45-minute session.
Contact: When necessary and as agreed upon with your child’s therapist and counselor, therapists are accessible via Sawa email during office hours (Monday to Friday, 9:00 am - 6:00 pm Beirut time). You can also contact your child’s counselor through email or the WhatsApp number shared with you. A reply will be sent within 24-48 hours.
Subscription and Payments:
Subscriptions: Sawa’s packages are automatically renewed depending on the number of sessions, we send payment reminders 3 days before the billing cycle to your registered email address.
Cancellations: you can cancel your subscription at any time, please make sure to message your counselor before the renewal. Any remaining sessions will remain in your credit for up to 3 months or can be transferred to another family member or friend if you decide not to continue therapy.
Pauses: Sessions can be paused for up to 3 months, and they will remain in credit.
Non-refundable: Packages paid on Sawa are non-refundable.
Payment Methods: Card, PayPal, Western Union, Whish Money, or Bank Transfer. Note: An additional 3% fee applies to any non-card payment options like PayPal, Western Union, and Bank Transfer payments.
Proof of Payment and Invoices: Available upon request from the counselor or Sawa’s support team (hello@sawa.health or via WhatsApp).
Parent Acknowledgment and Consent for Treatment:
I have read and understood this informed consent form.
I agree to the terms and conditions outlined above.
My consent becomes effective as soon as I subscribe to or use any of Sawa Health’s services for my child.
I agree to allow Sawa Health to provide therapy services to my child and to follow the outlined policies and responsibilities.