Informed Consent Form
Therapy with me is an intentional, collaborative, and relational space. I deeply honour your story, your agency, and your right to informed choices. This consent page is not just a legal formality—it is a transparent invitation into how I work, what you can expect, and how your rights and well-being will be held with care and respect.
The first step in any therapy journey is getting to know your therapist in detail and their professional journey of becoming a therapist. This fosters a sense of familiarity and trust. Therefore, I encourage you to read more About Me from the link below. Your trust in beginning your mental health journey is highly respected.

Consultation Details
Informed consent is not a one-time agreement—it’s an ongoing conversation rooted in transparency, choice, and collaboration. You’re always welcome to revisit, ask questions, or make changes at any point in the process.
Slot Types
- Standard Slots
- Sliding Slots
- Special Sliding Slots
Session Frequency
Session frequency is not fixed — it is shaped by your needs, capacity, and rhythm of life.
Most clients choose to meet weekly, while others prefer twice-a-month sessions or once a month, depending on what feels most supportive at a given time.
These decisions are always made collaboratively, taking into account your emotional readiness, affordability, and current life circumstances. What matters most is continuity rather than the number of sessions. Therapy grows through consistency and the safety of returning — not through how often we meet, but through how steadily we stay connected to the work.
Both online and in-person sessions are available, and you’re welcome to switch between them based on your comfort, schedule, or need.
- Online Sessions
- All virtual sessions are held on Google Meet through a HIPAA-compliant Google Workspace Business Standard.
- This ensures:
- Encrypted communication
- Secure cloud storage
- Confidentiality and data protection
- In-Person Sessions (On Pause!)
- Face-to-face sessions are available at my dedicated therapy space in:
- Hi-lite Business Park, Kozhikode (Saturday)
- The space is private, quiet, and designed to support comfort, safety, and confidentiality.
Types of Slots, Fee, Duration & Availability.
| Slot Types | Duration | Indian Slots INR (₹) | North America, Europe, Aus, SG Standard Slot (USD) | Middle East / GCC Standard Slot (AED) | Availability |
| Standard Slots | 60 Mins | 2,500 | 40 | 140 | 7 Days a Week 8:00 AM – 11:00 PM (Includes Public Holidays) |
| Sliding Slots* (On Pause!) | 50 Mins | 2,000 | 35 | 117 | Working Days 10:00 AM – 7:00 PM |
| Special Sliding** (On Pause!) | 40 Mins | 1,500 | 27 | 93 | Working Days 10:00 AM – 4:00 PM |
Sliding Slots*
These sessions are intentionally designed for clients who genuinely experience financial constraints and are unable to afford the standard fee.
Sliding slots follow a separate intake and review process. Submitting the sliding slot intake form does not confirm a session. Requests are reviewed after submission to understand the reasons for opting for a reduced fee and to assess current availability.
This process exists to ensure that the limited number of reduced fee slots are allocated ethically and with care. Sliding slots are specifically meant for clients who are unable to afford the standard fee and genuinely require financial flexibility.
Please note that registering for a sliding slot does not guarantee immediate availability. Depending on demand, a waiting period may apply. Detailed information about this process is provided in the sliding slot link shared at the end.
Special Sliding Slots**
Special sliding slots are the most limited and are offered only after a brief conversation to understand context and need. These slots exist for clients facing significant financial or systemic barriers to access. They are not an alternative pricing option but a focused equity based provision. Availability is reviewed periodically to ensure ethical use and sustainability.
| Notice Period (Before Scheduled Session) | Refund or Reschedule Eligibility |
|---|---|
| More than 24 hours | Full refund or full reschedule available |
| 24 to 12 hours | 75% refund or session transfer possible |
| 12 to 6 hours | 50% refund or transfer possible |
| Within 6 hours | 25% refund or transfer possible |
| No show without notice | No refund, full fee charged |
Appointment Cancellation, Rescheduling and No-Show
Your scheduled appointment time is exclusively reserved for you. Missed or cancelled appointments impact both of us. The following billing policy applies to all sessions:
Late arrivals: I wait up to 10 minutes. Sessions will end at the scheduled time and be charged fully regardless of late arrival.
Boundaries and Dual Relationships
Therapy works best when the relationship remains safe, professional, and clearly defined. I take great care to uphold these boundaries to protect your wellbeing and the integrity of our work together.
Avoiding Dual Relationships
To maintain a therapeutic space that prioritizes your care:
- I will not engage in friendships, business relationships, or any other non-therapeutic roles with clients.
- This includes connecting via personal social media accounts or dating platforms.
- Exchanging gifts or trading services is also not appropriate.
- Sexual or exploitative relationships with clients are strictly unethical and illegal, and I am committed to preventing any such dynamics.
Managing Pre-existing Relationships
If we discover that we have a pre-existing personal, professional, or social connection:
- We will talk about it openly to assess any risks to confidentiality or boundaries.
- If it could affect the safety or effectiveness of our work, I will support a transition to another trusted mental health professional.
Confidentiality in Public Spaces
To protect your privacy:
- I will not initiate recognition in public spaces. If you acknowledge me, I will respond respectfully, but please be aware that this may raise questions from others.
- You are free to decide how you wish to engage in such situations, and I will always honor your choice.
Session Process and Progress Concerns
Your voice matters in this process. I am committed to offering care that is respectful, collaborative, and accountable.
Your Rights and Safety
- You have the right to ask questions at any time—about the therapy process, my approach, or my qualifications.
- You are never obligated to continue therapy if it no longer feels right for you.
- You can request a referral to another professional without judgment or penalty.
If Something Feels Off
- If you ever feel unheard, unsupported, or uncomfortable with any part of our work, I invite you to share that with me directly.
- I take feedback seriously and am open to revisiting our process together to ensure that it remains safe and useful for you.
Commitment to Ethics
- I do not engage in social, romantic, or sexual relationships with clients—past or present.
- If at any point you believe my conduct to be unethical or harmful, you have every right to seek redress through relevant ethical or legal channels.
Fair and Inclusive Care
- I am committed to treating you with dignity and fairness, regardless of your race, caste, gender identity, sexual orientation, age, ability, religious beliefs, or financial situation.
Social Media Policy
To protect your privacy and uphold ethical boundaries, I maintain a clear separation between my personal and professional online presence.
What to Expect
- We will not connect through personal accounts, dating apps, or other private social platforms.
- You are welcome to follow or engage with my professional social media accounts, where I share therapeutic insights, resources, and updates.
Professional Boundaries Online
- Any interaction through my professional accounts will always remain within the scope of our therapeutic relationship.
- I will never discuss personal therapy matters or session content on social media.
- If we happen to be part of the same training, workshop, or professional group, I will continue to honor your privacy and safety by upholding strict ethical standards.
Termination of Therapy
Therapy is meant to support you until you feel ready to continue your journey without my involvement. While some people benefit from a few sessions, others may need long-term support. Regardless of duration, our goal is to work together meaningfully until a natural or necessary end point.
You Can End Therapy at Any Time
- You have full autonomy to stop therapy whenever you choose.
- If possible, I encourage you to attend one final session so we can review your progress, discuss next steps, and ensure a thoughtful closure.
If I’m Not the Right Fit
- If I come to believe your needs fall outside my expertise or scope of practice, I will share this openly.
- I will support you in identifying and transitioning to another therapist better suited to your needs.
In Case of Unexpected Events
- If I am ever unable to continue therapy due to severe illness or death, a trusted colleague will be assigned to manage transitions and ensure continuity of care to the extent possible.
When Therapy May Be Concluded by Me
I may initiate the end of our work together if:
- You engage in verbal or physical aggression towards me or my team
- There are threats made to my safety or that of my family.
- Sessions are attended under the influence of alcohol or drugs.
- Weapons are brought into the therapy space.
- The therapeutic relationship is used for illegal purposes.
- There is consistent non-payment for sessions despite reminders.
In such cases, I will communicate clearly and respectfully, and where appropriate, assist you in connecting with other professionals.
Therapy Quality Assurance
Providing ethical, effective, and meaningful care is a commitment I hold deeply. To ensure the quality of therapy remains high and responsive to your needs, I engage in the following practices:
1. Personal Therapy
I regularly attend personal therapy to reflect, stay grounded, and care for my own wellbeing.
This allows me to be more present and attuned in our sessions. It is also an ethical responsibility I take seriously.
2. Supervision
I am formally supervised by two experienced professionals, including one of my former professors.
Supervision offers space for critical reflection, clinical feedback, and accountability, ensuring you receive safe and thoughtful care.
3. Client Feedback
After each session, you’ll receive a short feedback form via email (takes less than 30 seconds).
Your reflections help me understand what’s working and where I can grow, ensuring our work remains collaborative and effective.
These ongoing practices help me uphold the ethics and integrity of our therapeutic relationship and support a space that centers your care.
Purpose and Process: A Trauma-Informed Approach
I am a trauma-informed counseling psychologist, which means, therapy with me is not about “fixing” you, because you are not broken. It is a process of witnessing, understanding, and integrating the parts of your story that have been silenced or overwhelmed. I practice from a Trauma-Informed lens. This means I move away from the question “What is wrong with you?” and instead explore “What happened to you, and how have you adapted to survive?” In our work together, we view your symptoms—whether anxiety, shutting down, perfectionism, or avoidance—not as disorders, but as creative, intelligent responses your nervous system developed to keep you safe. Our goal is to honor these protections while gradually helping you find new ways to thrive in the present.
WhaWhy We Go Slow: The Importance of Pacing
One of the most defining features of therapy with me is the pace: it is intentionally slow.
In a world that demands urgency and quick fixes, we often try to rush healing. However, rushing through trauma or deep emotional pain can often overwhelm the nervous system (a state often called “flooding”), which can leave you feeling unsafe or re-traumatized.
- We work with “Titration”: Think of this like a chemistry experiment where we add potent ingredients drop by drop. We will touch on difficult topics in small, manageable doses to ensure you remain grounded and present.
- Building Capacity first: Before we dive into the “deep end” of your history, we will spend time building your capacity to feel safe, regulated, and supported in the here-and-now.
- Respecting your “No”: If a topic feels too heavy or too fast, we stop. Slowing down is not resistance; it is a vital part of the work.
What a Trauma-Informed Session Looks Like
What a Trauma-Informed Session Looks Like
Since safety is the foundation of our work, our sessions might feel different from other appointments. Here is what you can expect:
Curiosity, Not Judgment: We view your symptoms (like anxiety, shutting down, or avoidance) as survival skills, not failures. We treat your coping mechanisms with respect, understanding they helped you get through difficult times.
You Set the Pace: You never have to “tell the whole story” to be a good client. You decide what to share and when. If a topic feels too heavy, we stop.
We Work as a Team: I am not here to tell you what to do. We decide together what to focus on. I will frequently check in to make sure the conversation feels right for you.
We Listen to Your Body: Healing isn’t just about talking. We might pause to notice how you are feeling physically—like tension or changes in breathing—to help you feel grounded and safe in the moment.
Potential Risks
While therapy can be supportive and transformative, it may also involve emotional discomfort. This is a natural part of the process, especially as we revisit past experiences or question familiar narratives.
Some possibilities include:
- Feeling emotionally raw or vulnerable during or after sessions
- Temporary increases in sadness, anxiety, confusion, or fatigue
- Shifts in how you see yourself or relate to others
- Disruption of old patterns that may feel unfamiliar or disorienting
These responses are not signs of failure but indicators of movement. You are always encouraged to speak up about any discomfort—we’ll hold space for it together, and make adjustments as needed.
The Goal of Our Work
The ultimate goal is not to erase your past, but to rob it of its power to control your present.
We aim to expand your “Window of Tolerance”—your capacity to sit with difficult emotions without being overwhelmed by them. Through this slow, collaborative, and respectful process, we work toward a place where you no longer feel defined by what happened to you, but empowered by the choices you make today.
Confidentiality
Confidentiality is a cornerstone of ethical therapy. What you share in our sessions stays between us. I take great care to protect your privacy, both within and beyond the therapy space.
What This Means in Practice
- I do not share information with family members, employers, or anyone else without your explicit written consent.
- You are always in control of what, how, and when you choose to share.
- I maintain minimal and secure records, stored on encrypted and privacy-compliant systems.
- In supervision, any case discussion is fully anonymized—your identity is never disclosed.
- If we meet outside therapy, I will not acknowledge you unless you choose to initiate contact.
Collaborative Transparency
- If a situation arises where breaking confidentiality might be necessary, I will:
- Discuss it with you in advance whenever possible.
- Share only the minimum information required for safety or compliance.
- You can always:
- Ask how your information is stored or used.
- Request to review your records or documentation.
Situations Where Confidentiality May Be Breached
Confidentiality may be legally or ethically breached under the following circumstances:
- Risk of serious harm to self or others – If you express clear intent to harm yourself or someone else, I may need to involve relevant support systems to ensure safety.
- Suspected abuse or neglect – If I become aware of abuse involving a child, elderly person, or vulnerable adult, I am legally mandated to report this (e.g., under the Protection of Children from Sexual Offences [POCSO] Act in India).
- Court directive or subpoena – I may be legally required to share information if a valid court order is presented.
- With your written consent – When you request or agree to referrals, coordination with other professionals, or report sharing.
In such cases, I will communicate clearly and respectfully, and where appropriate, assist you in connecting with other professionals.
Outside these rare exceptions, your privacy is protected. I adhere to ethical guidelines rooted in trauma-informed, anti-oppressive, and culturally competent care. Confidentiality is not just a rule—it’s a value I uphold with seriousness and respect.
Digital Safety and Data Protection
Your privacy and trust are at the core of our work. All therapy-related data—forms, notes, and communication—are securely stored within a HIPAA-compliant Google Workspace system and protected through encrypted, multi-layered security.
Legal Scope of Practice and Limitations
As a Counselling Psychologist practicing in India, I work within the ethical and legal boundaries of my role. My services do not include psychiatric diagnosis, medication, medico-legal certification, or emergency/crisis intervention.
If your needs extend beyond my scope, I will provide referrals to trusted clinical or psychiatric professionals to ensure continuity of care.
Consent to Begin
By continuing with therapy, you acknowledge:
- You have read and understood this informed consent
- You voluntarily agree to begin therapy within the above structure
- You understand your rights, responsibilities, and session fees
This informed consent assumes that you:
- Are over the age of 18.
- Are able to make informed decisions about your mental health care.
If you’d like to proceed: Please fill the Informed Consent Form and WhatsApp me or my session manager to receive the session booking link.
INFORMED CONSENT
Your story matters.
Your safety matters.
And your choice always comes first.
Please note that sliding slots are specifically intended for clients who are unable to afford the Standard slots. Availability, expected waiting period, and session duration for sliding slots may vary and are subject to the details outlined in the first table in the sheet.
