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Collateral Participant Services Agreement – Informed Consent

Last modified: August 2026

About This Agreement

This Collateral Participant Services Agreement – Informed Consent (“Participant Agreement”) applies to individuals who participate in LifeStance Health¹ treatment sessions in a supporting or collateral role — including parents/guardians, spouses/partners, and family members. This Agreement does not replace the Patient Services Agreement (“PSA”) signed by the identified patient. By signing, I acknowledge that I am not the identified patient, that my role is to support the therapeutic process, and that my participation may be modified or discontinued at the clinician’s discretion based on clinical appropriateness. Participating in sessions does not create an individual provider-patient relationship between me and the LifeStance clinician. If I need individual care, I should seek services separately.

By having provided LifeStance with my email address and/or phone number, I agree that LifeStance may send notices related to appointments, session scheduling, and other operational messages via email, phone, or text messaging (SMS).

Informed Consent to Participate

  1. My Role as a Collateral Participant. I understand that I am participating in a collateral or supportive capacity and that the treating clinician will determine the nature and extent of my participation. I acknowledge that therapy sessions may involve uncomfortable emotions, discomfort, and emotional distress, and that any lifestyle or behavioral changes could affect my relationships. There are no guarantees about outcomes. Personal health information I disclose during sessions may be documented as part of the therapeutic unit’s clinical record and is not maintained as a separate individual record for me. I agree that my relationship with the LifeStance clinician will remain professional at all times. If I have concerns, I may share feedback with the clinician or through LifeStance’s Patient Feedback Form.
  2. Confidentiality and “No Secrets” Policy. If I participate in couples, family, or group therapy, the couple, family, or group — rather than any individual — is considered the patient for confidentiality purposes. I acknowledge:
    • There are “no secrets” in couples and family therapy. Information disclosed at any point — including in one-on-one sessions — may be referenced in joint sessions as clinically appropriate, at the therapist’s discretion.
    • Therapy session records will NOT be released to any individual participant without written authorization from all participants who are legally able to consent under applicable state law, unless subpoenaed or court-ordered. In the case of a subpoena, LifeStance will contact all participants so they may contest it.
    • LifeStance is not responsible for one participant’s disclosure of another’s confidential information outside of therapy. Recording sessions without all participants’ express permission is prohibited.
  3. Parent/Guardian Participation for Minor Patients. If I am participating as a parent or legal guardian, I understand that the minor is the identified patient and the clinician will determine my level of involvement based on clinical judgment. I acknowledge that: (a) LifeStance may deny my request for copies of my child(ren)’s confidential mental health records if the clinician determines denial is warranted or required by law; (b) once a minor can independently consent to treatment under state law, I will only access their records with the minor’s consent or as required by law; (c) I must provide LifeStance with copies of all custody orders, divorce decrees, and parenting agreements addressing medical decision-making authority at or before the first appointment; and (d) if 60 days elapse following a request for these documents without a response, LifeStance may discontinue treatment. If I am consenting to a minor’s participation as a collateral participant (e.g., a sibling in family therapy), I represent that I have the legal authority to do so, that I have obtained consent from any other parent or guardian with shared legal custody or medical decision-making authority as required, and that I will provide supporting legal documentation upon request. If LifeStance receives an objection from another parent or guardian, LifeStance may suspend the minor’s participation until the dispute is resolved.
  4. Recording, AI, and Technology. I consent to the recording of phone calls and clinical appointments. Appointments may be recorded through a digital note taker; recordings may capture my voice and are transcribed shortly after the session through a third-party business associate vendor, after which the audio is permanently deleted. Recordings and transcripts are temporary documentation tools, are NOT part of the Designated Record Set under HIPAA, and are not maintained as part of the legal health record. LifeStance does not retain, produce, or release AI-generated recordings or transcripts in response to requests. I also consent to the use of artificial intelligence (AI) tools that assist clinicians with drafting notes, analyzing clinical data, and automating administrative functions. AI tools do not independently deliver care or engage in “therapeutic communication” with patients or participants. All AI-generated content is reviewed by the licensed clinician, who retains full responsibility for care. I may opt out of recording and/or AI-assisted services at any time by notifying LifeStance in writing and informing the treating clinician.
  5. Telehealth, Communications, and Privacy. I consent to participating in telehealth sessions when applicable and acknowledge that telehealth may not be as complete as in-person services, is not intended for emergencies, and involves technology risks. I may withdraw telehealth consent at any time. I understand that as a collateral participant, I will not have access to the LifeStance patient portal; communications will be conducted via unencrypted email, text (SMS), telephone, or U.S. mail. I acknowledge that unencrypted communications carry a risk of interception and could reveal my participation in therapy sessions. I can opt out of texts by texting “STOP” and emails by clicking unsubscribe. My consent to receive messages is not a condition of participation. LifeStance complies with applicable civil rights laws, the ADA (42 U.S.C. § 12101), and provides language assistance for limited English proficiency contact [email protected] for accommodations. Students, residents, or trainees under supervision may be present during sessions; I may withdraw that consent at any time. I acknowledge receipt of LifeStance’s Notice of Privacy Practices and the state-specific addendum for the applicable LifeStance location.
  6. Emergency and Mandatory Reporting. Notwithstanding any confidentiality provisions, LifeStance clinicians are legally required to disclose information without authorization when there is imminent risk of serious harm, reasonable suspicion of child/elder/vulnerable person abuse, a court order, or as otherwise required by law. These obligations apply to information disclosed by any participant, including me.

Legal Terms

Subpoenas, Custody Evaluations, and Legal Work. Should there be legal proceedings (including divorce and custody disputes), neither I, my attorneys, nor anyone acting on my behalf will subpoena LifeStance records or employees to testify. If subpoenaed in violation of this agreement, LifeStance will comply as required by law but may terminate the therapeutic relationship and/or my participation immediately. LifeStance employees will NOT provide custody evaluations, recommendations regarding visitation, legal advice, or expert testimony. If a LifeStance employee is subpoenaed to testify in proceedings related to services provided to me or my family, I will pay LifeStance for all related services at the rate of $75 per 15 minutes (minimum 3 hours / $900 for depositions and hearings), including travel, preparation, and testimony time.

Participation Discharge or Termination

The treating clinician may modify, limit, or discontinue my participation at any time based on clinical judgment and the therapeutic needs of the identified patient. LifeStance may terminate my participation if my behavior, communications, or actions are oppressive, violent, abusive, threatening, or constitute harassment, stalking, discrimination, or a violation of law. These are not exclusive lists. Violations of this Agreement, including disrespectful conduct toward LifeStance staff or unauthorized recording of sessions, may also result in termination of my participation.