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Informed Consent for Psychological Assessment

This document outlines the informed consent for a psychological assessment. It details that standardized psychological tests will be used and the participant has a right to inquire about procedures and stop the assessment if uncomfortable. All information collected will be kept confidential according to privacy laws and only accessible by authorized personnel. The data will only be used for educational and research purposes and identifying information will be kept anonymous. Signing indicates understanding and consent to participate in the assessment.

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Klein Xavier Boiser
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2K views2 pages

Informed Consent for Psychological Assessment

This document outlines the informed consent for a psychological assessment. It details that standardized psychological tests will be used and the participant has a right to inquire about procedures and stop the assessment if uncomfortable. All information collected will be kept confidential according to privacy laws and only accessible by authorized personnel. The data will only be used for educational and research purposes and identifying information will be kept anonymous. Signing indicates understanding and consent to participate in the assessment.

Uploaded by

Klein Xavier Boiser
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
  • Informed Consent Form: Provides essential information for participants about the psychological assessment process, including privacy and data handling.

INFORMED CONSENT FORM

The information stated below will provide you with information with regard to the service,
particularly psychological assessment. May you have questions regarding the information
mentioned, you are free to contact our subject instructor or Attending Registered
Psychometrician/Psychologist. Your signature along with your printed name below indicates you
have understood and are fully aware of the information mentioned and you voluntarily
participate in this assessment.

Psychological Assessment
This assessment relies upon standardized psychological tests that will guide the
discourse of assessment and observation. Throughout the process, you have the right to inquire
about the nature and/or the purpose of all the procedures within this assessment. This
assessment observes ethical standards and guarantees a humane process. However, you have
the right to stop the assessment anytime you want if you feel you are not safe and no longer
comfortable proceeding with the assessment.

Confidentiality of Information
All data gathered that is either personal and/or results of the assessment, as well as the
audio recording, will be treated with full confidentiality in observance of the Data Privacy Act of
2012 and will be handled by authorized personnel only. Used instruments containing data and
results will not be accessed by the general public as they will be stored in a safe and dry place.
If in any instance that there is a court ruling ordering the production of a copy of the
psychological and assessment forms, the mental health professionals in this assessment will
work hand-in-hand with the court in compliance with the ruling while ensuring the safe transfer
of data and records. Rest assured that the original copy will be kept by the mental health
professionals.

Assessment Tool/Instruments
This assessment will use standardized psychometric tests as an assessment tool.
Printed psychometric tests and papers will be provided as an instrument.

Professional-in-Charge
The professional in charge of this assessment is a duly registered and licensed
professional by the Professional Regulation Commission of the Philippines under the Board of
Psychology.

Informed Consent Form - 1


Fee and Payment Policy
The entire psychological assessment procedure is free as the assessor is a psychology
student.

Release of Data
To maintain confidentiality and with compliance to the Data Privacy Act of 2012, the
collected data will be shared ONLY with authorized and legal parties with the closest relation to
the patient together with evidence such as written and signed consent and photocopy of the
identification cards of both the patient and authorized person.

Use of Data
The data will be used for educational and research purposes ONLY. Personal identifying
information of the patient will be anonymous and will be kept confidential with the utmost
respect.

Informed Consent
I have fully understood the information outlined in this form and voluntarily undergo the
psychological assessment.

_______________________________
Signature over Printed Name

Date: _________________________________

Informed Consent Form - 2

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