Consent Form

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This is an out patient psychiatric clinic, which means that the doctors/psychologists see patient on an appointment basis as required. The first visit generally of a session between 30-60 minutes. During this visit the doctor/psychologist attempts to assess your situation in detail with a view to understand your problem and suggest a treatment plan. The follow up appointments after your initial review generally lasts for 30 minutes. However the duration of the same may change based on your needs.

Treatment offered

The clinic offers treatment in the form of medications and psychotherapy.
The doctors will make an attempt to choose the medications that is right for you. As might understand every brain/body is different. There is risk of side effects with the medications. By accepting the same you accept the risk and benefits of the same.
Psychotherapy is commonly referred to as talk therapy. It is offered both by psychiatrists and psychologist in the clinic. It is common and effective modality of treatment when used alone or with medications. If you accept to undergo psychotherapy you agree to follow up with clinician at suggested intervals.
The clinic also offers psychological assessment for adults along with family counselling/therapy.

Frequency of clinic attendance

Frequency of your visit varies based on your needs and situation. It may vary between weekly visits for a patient who is undergoing psychotherapy as compared monthly follow up for some one who is just on medications and doing reasonably well.

Emergency/Crisis treatment

The clinic is an outpatient clinic, which sees patient based on prior appointments. The clinic only runs during the daytime. It does not offer emergency care. If you are experiencing an emergency (Example: Feeling suicidal, having thoughts of hurting others, not able to eat or during hence resulting in significant weight gain and any other emergency) you should contact the nearest psychiatric hospital for help.
Doctor would be very happy to discuss your emergency crisis options during regular visit to the clinic.


The clinic charges fee for the service offered. The fee depends on the type of the service offered.

Your responsibility

As patient you form the centre of your recovery and your role in improving including maintain your health is paramount. By working with our clinicians you agree to make a commitment to your recovery by following the treatment as suggested by them. This includes regularly taking medications, attending follow-up as advised, and attending psychotherapy sessions as advised along with ongoing commitment to practice skills discussed in psychotherapy.
It is needless to say that your recovery may be compromised in the absence of your efforts.


The information provided by you is sensitive and private. The doctors and psychologists will make every attempt to keep it confidential.
There might be some exceptions to the above (Please see below in the section related to disclosure).


Information provided by you may be discussed with your loved ones to facilitate your ongoing care and recovery.
The treatment doctor can discuss your care with a medical doctor, who may be involved in care to facilitate better communication for his best care. 
The clinicians may breach confidentiality if they are worried about your or others safety.

Involvement of family

The clinician/staff in the clinic may talk (In person or over the phone) to your family to collect information to help understand your illness/ situation and give information to them to help your ongoing recover/management.
I have read the above information and understand the same.

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