Professional Documents
Culture Documents
PSY 8350
Email: jameeliab@icloud.com
Informed Consent
1812 NorthBend Rd
Cincinnati, OH 45218
Phone: (513) 821-3286
Fax: (513) 821-7896
Name: Faith Evans
Date: June 13,2019
You have been referred to Dr. , PhD in relation to your legal situation.
You have been referred for a psychological evaluation to be conducted alongside your court
proceedings. After the evaluation has been completed, a report will be written and provided to
the attorney that has recommended you for these services. Any private correspondence will still
remain under attorney-client confidentiality unless your attorney deems that it should be
provided to the court. The information that will be provided in the report will be made available
to your attorney along with the prosecutor in accordance with court law, the information will be
objective and will utilize professional judgment, please keep in mind that anything disclosed
during the evaluation is subject to be entered into the report. Additionally, there is a possibility
that the information in the report be asked to be relayed through testimony, in this instance the
above still applies and anything that was said during the evaluation is subject to be included in
said testimony.
The goal of the assessment is to answer questions about you and any difficulties that you may be
having. The assessment will contain several parts, an interview, psychological testing and review
of records and interviews of collateral contacts such as friends and family. The first part will deal
with the actual psychological testing. These will be standardized psychological tests which will
be discussed and explained in detail at the time of the evaluation so that you understand them
fully before taking the test. A benefit of this is that if you were to have any questions regarding
the test at any point or you are unclear of what the instructions are you will be able to ask prior to
the test. In the interview portion of the evaluation, this will include the interview of the collateral
contacts as well, you will be asked about yourself, your life and also about the situation that has
prompted the referral for a psychological evaluation. The collateral interviews will be a list of
people that you have given consent to be talked with and will help in understanding the
information that you have provided.
Please remember that in order to give a complete and accurate psychological evaluation it is
important that you be as honest as possible in all areas of the evaluation. Misinformation may
negatively impact the results and can in some instances be more damaging if found out after the
report has been provided to the courts. If at any time there is information that you wish to present
that was not mentioned during any part of the evaluation please do not hesitate to discuss them.
Please read each item below and sign the document indicating that you have fully understood the
following statements:
• I understand that this release is for the purpose of forensic consultation
• I understand that there will be a formal report written and or given orally based on the results of
this assessment.
• I understand that as part of conducting this forensic evaluation, consultation and exchange of
information will be done with anyone that may be relevant to this legal matter.
• I understand that state laws may require the disclosure of otherwise privileged information in
situations of suspected child or elder abuse, suspected potential harm to oneself or to another, in
which case the courts may subpoena for these records.
• I agree that this is a legally binding document and that I fully understand the rights,
confidentiality, and privileges that I waive by signing this document .
• By signing below, I indicate that I understand and agree to the nature and purpose of this
assessment, to the ways in which it may be reported, and to each of the points listed above.
_________________________
Name (Print)
__________________________ ______________________
Signature Date
_____________________________________ ________________
Signature of Client (or Authorized Guardian) Date
Forensic vs. Clinical Documentation
The documentation within each area of psychology differs whether it is forensic, clinical
when a practitioner informs the client of their rights as well as their responsibilities during the
process or evaluation that they will be taking part in. The informed consent form, though it is
required in each area of psychology still differs based on what is going to take place. For
instance in a clinical setting where the clients is receiving or taking part in a treatment based
program, the informed consents details multiple aspects of the therapy process such as the
services, the meetings, fees, billing and payments, confidentiality and how to contact the
therapist. In a forensic setting the informed consent is straightforward and to the point it goes
over the purpose of the evaluation, what, how and to whom information will be released, which
information will be included in the written report, rights of the person being evaluated and
limitations to confidentiality. One main detail that is drastically different from a forensic
psychology standpoint is the confidentiality aspect. In a clinical setting, if the client were to have
any legal issue he or she has the right to stop the therapist from providing information to the
court, of course unless it has been ordered from the court. Clients in a clinical setting are
informed beforehand that the information that they provide typically will not be disclosed
outside of that particular setting unless legal issues arise and the therapist is subpoenaed. In a
forensic setting the client is also aware that the information they provide is subject to be heard by
the courts, they do not get a say in what can and cannot be told to the parties wanting the
psychological assessment to be done, anything that the client says in this forensic setting can be
setting the evaluee is not a client and therefore the confidentiality rules do not apply to a certain
extent. The forensic psychologist Is required to release information to the courts in court ordered
psychological assessment. However, the actual release of information is completed so that the
forensic psychologist may not only send records but request and receive them as well. During an
evaluation the forensic psychologist will need to collect information that is pertinent to the
evaluation which may include medical history among the many other requirements. This consent
form gives the psychologist access to said records. Overall the main difference in relation to
consent is that the release of information is a decision that the client must agree on the exception