The Somers Trust
Psychological Associates
Center for Comprehensive Psycholical Services
873 Turnpike St., North Andover, MA 01845-6152
TEL. (978) 688-8004
FAX (978) 686-8554
CHILD AND ADOLESCENT CONFIDENTIALITY
Welcome to Somers Trust. The following contains information about confidentiality when providing
psychological services to minor children. Please read it carefully and feel free to ask any questions you
might have when you meet with your child’s therapist.
If your child or adolescent is under 18, unless you have been legally stripped of your parental rights, as a
custodial or non-custodial parent you have the right to have access to your child’s psychological records.
However, once your child reaches 18, you will no longer have the privilege of access to the records
without a waiver of confidentiality from child.
Confidentiality between patient and therapist is an important part of the therapeutic process. For your
child or adolescent to feel comfortable opening up to his or her therapist, your therapist would have to
assure him or her that not everything he or she says will be reported to mom and dad. Bear in mind that
one of the reasons you have chosen to have your child or adolescent speak to an outside party is because it
can be difficult for he or she to discuss certain matters with their parents. The therapist may wish to come
to an agreement with you at the beginning of treatment as to what will be revealed to you and what will
remain between patient and therapist.
Your therapist will be happy to clarify his or her position based upon the unique needs of your child.
Your signature below indicates that you have read the information in this document and agree to abide by
its terms during our professional relationship.
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Child’s Name
Parent/Guardian Signature
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Witness Signature
Date