Please fill out this form as best you can.
Consent for Social Work Services I, Samantha Edelman, am a Master of Social Work (MSW) intern enrolled in Boston University's social work program. As part of my educational requirements, I will be providing social work services under the supervision of Yaffa Tilles at Boston Birth Village.
Please read, complete and submit to indicate your understanding and consent.
Nature and Purpose: I will offer support, guidance, and resources for social and emotional concerns.
Confidentiality: Your privacy is respected, but there are exceptions as mandated by law.
Risks and Benefits: Therapy can help, but may also bring up difficult emotions.
Alternatives: You have the right to explore other forms of support and can stop sessions at any time.
Fees and Payment: Services are provided at no charge.
Rights and Responsibilities: You have the right to participate in your treatment and are responsible for attending appointments.