Counseling Agreement for Sample PDI

In this section would be special information regarding the counseling process, confidentiality, reasons for terminating counseling, etc.

I, ______________________, have carefully read the conditions for counseling set forth in this document and agree to enter into counseling in accordance with them.

Signature: _______________________   Date: _____________________

I am filling out this PDI form on behalf of the counselee:

My name: ___________________________ Relationship: _______________________