Counselling Client Information Form

Counselling Client Information Form Template for Malaysia

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Key Requirements PROMPT example:

"I need a Counselling Client Information Form for my new private practice opening in March 2025, focusing on adult clients and including both in-person and online counselling services, with emphasis on data protection and electronic communication consent."

Document background

The Counselling Client Information Form is a crucial document used in Malaysian counselling practices to establish the professional relationship between counsellors and clients. This form serves multiple purposes: collecting essential client information, documenting informed consent, and ensuring compliance with Malaysian healthcare regulations and data protection laws. It is typically used at the initiation of counselling services and includes sections for personal information, medical history, consent declarations, and emergency contacts. The document must comply with the Counsellors Act 1998, Personal Data Protection Act 2010, and relevant Malaysian healthcare regulations. It's designed to protect both the client's interests and the counsellor's professional practice while facilitating effective treatment planning and risk management.

Suggested Sections

1. Personal Information: Client's basic details including name, IC/passport number, date of birth, contact information, and preferred method of contact

2. Emergency Contact Details: Name, relationship, and contact information for emergency situations

3. Medical and Mental Health History: Current medications, previous counselling experience, relevant medical conditions, and current mental health concerns

4. Presenting Issues: Primary reasons for seeking counselling and current concerns

5. Confidentiality Statement: Explanation of confidentiality policies and its limitations under Malaysian law

6. Consent Declaration: Client's acknowledgment and consent to counselling services and information handling

7. Risk Assessment: Basic screening for immediate safety concerns and risk factors

Optional Sections

1. Insurance Information: Required if client is using insurance to cover counselling services

2. Payment Agreement: Include for private practice settings where payment is required

3. Cultural/Religious Considerations: Optional section for noting specific cultural or religious preferences that may affect counselling

4. Family History: Detailed family mental health history when relevant to treatment

5. Referral Source: Information about how the client was referred to the service

6. Electronic Communication Consent: Required if offering online counselling or communication via digital platforms

Suggested Schedules

1. Privacy Policy: Detailed explanation of how personal information is collected, stored, and used in compliance with PDPA 2010

2. Fee Schedule: Breakdown of service fees and payment policies if applicable

3. Client Rights and Responsibilities: Detailed outline of client rights under Malaysian law and counselling ethics code

4. Crisis Management Plan: Protocol for emergency situations and after-hours support

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

Relevant legal definitions

Clauses

Relevant Industries

Healthcare

Mental Health Services

Education

Social Services

Corporate Wellness

Non-Profit Organizations

Employee Assistance Programs

Private Practice

Relevant Teams

Mental Health Services

Clinical Operations

Healthcare Administration

Compliance and Legal

Medical Records

Client Services

Wellness and Support

Quality Assurance

Relevant Roles

Counsellor

Psychotherapist

Clinical Psychologist

Mental Health Professional

Healthcare Administrator

Practice Manager

Compliance Officer

Medical Records Officer

Mental Health Service Coordinator

Wellness Program Manager

Student Counsellor

Employee Assistance Program Coordinator

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