Treatment Consent
1. Voluntary participation and right to terminate
Psychotherapy and group therapy at Pasadena Clinical Group are voluntary. You may decline to answer any question, decline any specific intervention, and end treatment at any time. You are encouraged to discuss any concerns about your care with your clinician. If you choose to terminate, we will provide referrals on request and, where clinically indicated, recommend a transition plan.
2. Nature of services
Pasadena Clinical Group provides outpatient psychotherapy, including individual therapy, couples counseling, group therapy, family therapy, and an Intensive Outpatient Program (IOP). We are not a 24-hour, residential, detox, or emergency-services provider, and we do not provide medication management. If your situation requires those levels of care, your clinician will discuss referrals with you.
3. Risks and benefits of psychotherapy
Therapy can produce significant benefits, including reduction of distressing symptoms, improved relationships, and increased self-understanding. Therapy is not, however, without risk. Discussion of difficult topics may temporarily increase distress, raise unexpected feelings, and challenge existing beliefs. Outcomes cannot be guaranteed.
Group therapy carries an additional risk that other group members may, despite written agreements, share information outside the group. We address this risk through explicit group agreements, but full confidentiality cannot be guaranteed in a group setting.
4. Confidentiality and its mandatory California exceptions
Communications between you and your clinician are generally confidential, protected by HIPAA, the California Medical Information Act (CMIA, Civil Code §56 et seq.), and California psychotherapist-patient privilege (Evidence Code §1010 et seq.). However, California law requires us to break confidentiality and report or take action in the following circumstances:
- Suspected child abuse or neglect — California Child Abuse and Neglect Reporting Act, Penal Code §11164 et seq.
- Suspected abuse, neglect, or financial abuse of an elder or dependent adult — Welf. & Inst. Code §15630.
- Threats of serious physical violence against a reasonably identifiable victim — duty to warn or protect, Civil Code §43.92 (the Tarasoff duty).
- Imminent danger to self — when there is a serious and imminent risk of suicide or other self-harm, we may take steps to protect your safety, including coordination with emergency services or initiation of an involuntary hold under California Welf. & Inst. Code §5150.
- Court orders, subpoenas, and lawful process — we comply with valid legal process and notify you where permitted by law.
- Insurance and payment — disclosure of the minimum necessary PHI to insurance carriers for benefits verification, prior authorization, and payment.
Your clinician will discuss any anticipated breach of confidentiality with you in advance, where clinically and legally possible.
5. Communication outside session (email, text, phone)
By signing this consent, you agree that we may communicate with you regarding scheduling, billing, and non-clinical matters by email, phone, or text — at the contact details you provide — using ordinary, non-encrypted channels. You acknowledge that ordinary email and SMS are not secure. We will not send PHI by these channels, and you are encouraged not to send PHI to us in this way. For sensitive clinical matters, please call or use the secure messaging method we provide.
6. Telehealth-specific consent
If you receive any portion of services via telehealth, the additional consent provisions in our Telehealth Agreement apply. Telehealth services are governed by California Bus. & Prof. Code §2290.5.
7. Records and retention
We maintain a clinical record of your care for at least seven (7) years from the date of last service for adult patients (and longer where required for patients who were minors at the time of service). You have a right to inspect and copy your records (Cal. Health & Safety Code §123100 et seq.) and to request amendments — see our Notice of Privacy Practices.
8. Consent for minors (informational only)
Pasadena Clinical Group is an adult outpatient practice. We do not generally treat minors as primary clients. Where a minor is present in family therapy, California Family Code §6924 permits a minor 12 years of age or older who is mature enough to participate intelligently in mental-health treatment to consent to outpatient mental-health treatment under specific circumstances; we apply the requirements of §6924 in any such situation. For dedicated minor treatment, we refer to a child or adolescent specialist.
9. Fees, billing, and insurance
Fees, billing practices, sliding-scale availability, and insurance acceptance are described on our Insurance page and on our Office Policies page. Payment is due at the time of service unless other arrangements have been made. By signing, you authorize Pasadena Clinical Group to bill your insurance carrier and to release the minimum necessary PHI required for benefits verification and claims processing.
10. Acknowledgment
By signing the intake form that incorporates this consent, you acknowledge that you have received, read, and understood this Treatment Consent and the Notice of Privacy Practices; that you have had an opportunity to ask questions; and that you are entering treatment voluntarily.
11. Contact
Pasadena Clinical Group · 301 N. Lake Ave, STE 600, Pasadena, CA 91101 · (626) 354-6440 · office@pasadenaclinicalgroup.com