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Sport Psychology Informed Consent Form

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SPORT PSYCHOLOGY PROGRAM INTERNSHIP
INFORMED CONSENT FORM – FORM F

The student-intern will turn in a copy of this to the Sport Psychology Program, give the client a copy, and keep a copy for their files.

I, , hereby give my permission to

, a Sport Psychology Master’s Degree Student at John F. Kennedy University, College of Graduate and Professional Studies, to apply his or her knowledge of the theories, research and techniques in the field of Sport Psychology. The application of this knowledge is viewed primarily as an educational enterprise. This may include:

1. Teaching participants specific performance enhancement skills for application in sport, exercise, and other contexts. Examples of techniques include relaxation, concentration, imagery, positive self-talk, and centering.

2. Within performance settings, helping participants understand, measure, and improve elements of their performance through strategies such as goal setting, etc.

3. Educating teams, organizations and groups on topics such as communication, leadership and team cohesion.

Sessions will generally take place at the training facility; in the event that the training facility is unavailable, a mutually agreed-upon location (between parent/guardian, client, and student-intern) will be used. Additionally, contact with the client may be done via phone, email, and text.

Confidentiality

It is understood that the student-intern will keep all sessions confidential, but in the event the client is to potentially cause harm to oneself or another, or there are signs of abuse (e.g., child abuse, elder abuse), the JFKU Sport Psychology Program requires that the student-intern break confidentiality by informing the appropriate school officials, primary site contact, or other necessary professional. In addition, if the student-intern suspects habitual substance abuse, this may be grounds to break confidentiality.

In the event something arises that is outside the student-intern’s scope of practice, a referral will be made to the client to see the school psychologist, counselor (or similar school or outside resource), or if not at a school site, to an outside professional referral. The Sport Psychology Program student-intern has permission to follow up with the person the client was referred to ensure that the client has made contact with the appropriate resource. When working with minors, the student-intern may also encourage the client to share with his/her parents or guardian that they have been referred to another professional resource; and, in some instances the student-intern may also break confidentiality and tell the parent/guardian about a referral if the student-intern feels this is appropriate (i.e., in the best interest of the client).

It is also understood that the Sport Psychology Program student-intern reports to their supervisor and a case seminar class all information gained through work with this team, athlete or organization. The Sport Psychology Program student-intern’s supervisor will usually make at least one site visit. The Supervisor also requires that the student-intern audio record work performed, and possibly video record. These recordings may be used in supervision meetings and/or case seminar class.

Sport Psychology Program Student-Intern Signature

Signature of Client

Signature of Parent/Guardian (If client is under the age of 18)

Emergency Contact Name, Relationship to client

The student-intern will turn in a copy of this to the Sport Psychology Program, give the client a copy, and keep a copy for their files.

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What the Sport Psychology Informed Consent Form Covers

The Sport Psychology Informed Consent Form documents an athlete's voluntary agreement to participate in sport psychology services, explains the scope and limits of care, and records key administrative details. It typically covers confidentiality, limits of confidentiality for safety reporting, session scheduling, fees, emergency contact information, and data retention practices to ensure informed decision making before services begin.

Why a Clear Consent Form Matters for Athletes and Practitioners

A well-drafted consent form protects client rights, clarifies treatment expectations, and documents legal consent for mental health services. It also helps clinicians meet professional and regulatory obligations, streamline intake, and reduce later disputes about scope of care or data sharing.

Why a Clear Consent Form Matters for Athletes and Practitioners

Who Typically Completes This Consent Form

A Sport Psychology Informed Consent Form is completed by parties involved in psychological services for athletes and teams.

  • Sport psychologists and licensed mental health clinicians working with individual athletes or teams, documenting scope, confidentiality limits, and billing arrangements.
  • Athletes or their legal guardians, providing informed consent, emergency contacts, and health disclosures required before beginning sessions.
  • Coaches, team administrators, or school athletic departments when organizational consent, team policies, or shared-care arrangements are involved.

Proper completion ensures clinical clarity, supports compliance with privacy laws, and reduces administrative friction during intake and follow-up.

Step-by-Step: Completing the Consent Form

Follow these steps before the first session to ensure informed, documented consent and operational readiness.

  • 01
    Review Form: Read full form and ask questions about terms.
  • 02
    Provide Details: Enter name, DOB, contact, and medical history.
  • 03
    Confirm Limits: Acknowledge confidentiality limits and emergency procedures.
  • 04
    Sign and Date: Sign, date, and return copy to clinician.

Essential Elements to Include in a Professional Consent Form

A complete consent form combines legal clarity, clinical details, and administrative data so both parties understand responsibilities and limits from the outset.

Scope of Services

Describe specific interventions, goals, session format (individual, group, remote), and expected frequency to set clear treatment boundaries and expectations.

Confidentiality

Explain confidentiality rules, exceptions for harm or abuse reporting, mandated disclosures, and how clinical records are stored and shared.

Risks and Benefits

Outline potential psychological risks, possible benefits, and alternatives so the client can weigh informed choices before beginning treatment.

Fees and Billing

State session fees, insurance billing practices, missed appointment policies, and any collection procedures to prevent billing surprises.

Emergency Procedures

Provide instructions for crises, including after-hours contacts, local emergency numbers, and steps if immediate safety concerns arise.

Data Use

Specify how records are used, who may access them, and whether de-identified data may be used for research or team performance reviews.

Data Security and Compliance Features to Note

Encryption: TLS 1.2/1.3; AES-256
Access Controls: Role-based access
BAA Availability: HIPAA BAA required
Audit Trail: Complete signing logs
Retention: Configurable retention
Redaction: Selective data masking

Risks and Legal Consequences of Incomplete or Incorrect Consent

Invalid Consent: Treatment disputes possible
HIPAA Violations: Potential civil fines
Malpractice Exposure: Increased liability risk
Breach of Confidentiality: Client harm and sanctions
Billing Errors: Claims denied or penalties
Regulatory Penalties: State licensing consequences

Common Mistakes to Avoid When Preparing the Form

  • Using vague language about confidentiality that fails to explain mandatory reporting and safe disclosure limits, causing misunderstandings later.
  • Omitting emergency contact or medical history details, which can delay appropriate clinical action in crises or complicate care decisions.
  • Failing to document guardian consent for minors or not checking state-specific minor-consent rules, risking invalid consent.
  • Not retaining a signed copy in the client file or electronic record, undermining proof of informed consent if challenged.

How Electronic Consent and eSigning Typically Work

Electronic consent follows a straightforward workflow that captures intent, identity, and a durable record for compliance and auditability.

  • Upload Document: Clinic uploads consent template for signing.
  • Place Fields: Add signature, initials, and date fields.
  • Authenticate: Signers confirm identity and consent.
  • Store Record: Signed copy plus audit trail stored securely.

Configuring an Online Consent Workflow

Set fields, authentication, routing, and storage to match clinical and privacy requirements before sending for signatures.

Field Configuration
Signature Block Required signer, date, and role fields
Conditional Fields Show guardian fields if minor selected
Authentication Level Email plus SMS code for higher assurance
Storage Location Encrypted cloud repository with retention policy

Technical and Integration Considerations

Choose a platform that supports secure storage, audit trails, and HIPAA-compliant workflows when handling PHI.

  • File Formats: PDF, DOCX supported
  • Integrations: Google Workspace, Microsoft 365
  • Authentication: SMS, KBA, SSO options

Timelines and Time-Sensitive Requirements

Certain dates and response times are important for legal access, revocation, and annual review of consent documentation.

Submission Before First Session:

Consent should be signed prior to or at the first appointment.

Effective Date:

Enter start date as MM/DD/YYYY; services begin on that date.

Annual Review:

Recommend annual review and reconsent for ongoing services.

Revocation Notice Period:

Clients may withdraw consent; allow reasonable notice, commonly 30 days.

HIPAA Access Timeline:

Respond to records requests within 30 days (45 CFR §164.524).

eSignature Vendor Comparison Relevant to Consent Forms

Comparison of common eSignature plans for organizations managing consent forms. signNow appears first to show available price and compliance features at a glance.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day trial No No Yes, limited Yes, limited
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Frequently Asked Questions About the Consent Form

Answers to common practical and legal questions about using, storing, and eSigning Sport Psychology Informed Consent Forms.


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