Informed Consent and Parental or Legal Guardian Authority for Treatment of a Minor

Consent to Treatment

I, the undersigned, am the parent/legal guardian of the above-named child and I hereby consent to my child’s participation in mental health counseling provided through Spring Care, Inc. and its subsidiaries and affiliates, including Spring Care Limited (Ireland), operating under the brand name Spring Health.

Nature of Counseling

I understand that mental health counseling may involve discussing issues that may be sensitive or difficult for my child. These may include family relationships, school experiences, personal growth, and emotional well-being. The goal of counseling is to assist my child in developing coping strategies, improving emotional regulation, and enhancing overall mental health.

Confidentiality

I understand that the confidentiality of my child’s counseling sessions is protected by law. Information disclosed during counseling will not be shared with others without my written consent, except in cases where the law requires disclosure. These exceptions include situations where there is a risk of harm to my child or others, suspected child abuse, or as required by a court order.

Limits of Service

I understand that mental health counseling is not a guarantee of improvement and that outcomes may vary. I acknowledge that counseling services are not a substitute for medical care, and I should seek medical advice if needed.

Parental Authority

By establishing this account on behalf of the minor child,  I represent that:

• I have the sole legal right to consent to treatment for my child; **OR**
• I have obtained the consent of the other parent/legal guardian to enroll my child in mental health counseling.

Consent and Agreement

I acknowledge that I have read, understood, and agree to the terms outlined in this parental consent  as well as the Consent to Treatment. I voluntarily consent to my child’s participation in mental health counseling with Spring Health.

If you have any questions or concerns regarding this consent form or the counseling process, please do not hesitate to contact careteam@springhealth.com