Informed Consent to Treat Minor Children
Including Patient Rights and Responsibilities
Last updated: December 27, 2024
It is the general policy of Neuroscience Psychiatry to obtain the informed consent of a parent or legal guardian prior to permitting minors (in most states, individuals under the age of 18) to access the online services (“the Services”) provided by licensed therapists and clinicians affiliated with Neuroscience Psychiatry and/or the Neuroscience Psychiatry & Integrative Wellness PLLC (“Provider(s)”).
By proceeding, you acknowledge that you understand and agree with the following and that the following representations are true:
I attest that I am the rightful parent or guardian of this minor and am legally empowered to consent to the provision of healthcare services for the minor.
I give consent for Neuroscience Psychiatry–affiliated Providers to provide mental health care to the minor, which may include medication and/or therapy, based on the treatment plan(s) I register the minor for and as long as such treatment is deemed clinically appropriate by the minor’s Provider(s). I understand that under no circumstances shall a Neuroscience Psychiatry–affiliated Provider prescribe a controlled substance to the minor, and that I should not register the minor for Services if my expectation is for the minor to be prescribed a controlled substance.
In addition to this consent, I have read and consented to the Neuroscience Psychiatry Terms of Use and Informed Consent for Treatment.
I understand I can revoke this consent at any time by emailing [email protected].I may have certain rights related to my participation in the minor’s care. I understand that I am invited to attend the minor’s initial consultation with a Provider, but may or may not be invited to participate in subsequent consultations based on what the Provider(s) deem is in the best interest of optimizing the Services provided to the minor. I understand that when the minor reaches the age of majority, they may unilaterally revoke my right to participate in their care.
I understand and the minor consents that, in accordance with terms and administrative protocols of Neuroscience Psychiatry’s Teen Care program, I shall maintain primary custody over the minor’s protected health information until the minor reaches the age of majority. This shall include, but not be limited to, the ability to access, disclose, and make decisions regarding my child’s medical records and related health information. A comprehensive explanation of how the minor’s medical records may be used or disclosed can be found in Neuroscience Psychiatry’s Notice of Privacy Practices.
I realize that the information related to my child’s treatment will remain confidential in line with all applicable laws and regulations, but that certain circumstances may require the Provider(s) to disclose certain information to third parties such as emergency service personnel or legal authorities. Such disclosures may occur if a Provider determines that the minor poses a serious threat of harm or death to themselves or another person, or if a Provider believes that the minor has been in some way neglected or abused.
I understand that Providers are not equipped to handle psychiatric or medical emergencies and that I will call 911 or go to the nearest emergency room if such a situation arises.
I understand that I will no longer be involved in the teen’s care when they reach the age of majority; however, their plan will not be canceled and the form of payment and/or insurance will remain the same unless either party cancels payment or the teen updates their payment information. Consequently, I may continue to receive financial information from Neuroscience Psychiatry or my insurance provider pertaining to the teen’s care.
I am authorized to consent on the minor’s behalf and acknowledge and agree to all terms listed above.
Need Answers? Common Questions
Will I lose control or “go crazy”?
No. While experiences can be intense, they are temporary, safe in the right setting, and often deeply meaningful. You will be supported at every step.
Are there side effects?
Some people may feel nausea, dizziness, or emotional intensity during their session. These effects are usually short-lived, and our team helps you navigate them safely.
Do I have to live in Colorado?
No. Anyone age 21+ is eligible to participate in guided sessions here in Colorado.
Will this show up on a drug test?
Routine employment screens do not test for psilocybin. Specialized tests exist but are rarely used.
Why Choose Neuroscience Psychiatry?
Unlike many retreat-style programs, our approach combines:
👉 Medical oversight by a licensed psychiatric provider
👉 Comprehensive evaluations before any session
👉 Evidence-based preparation and integration support
👉 A neuroscience-forward approach that blends psychiatry, therapy, and natural medicine
Curious if natural medicine is right for you?
Schedule your comprehensive evaluation today and explore your safest, most effective options.
Need Answers?
Frequently Asked Questions to General questions
Who is Neuroscience Pscyhiatry for?
Neuroscience Pscyhiatry provides online mental health care to individuals 6 years and older. Our expert providers can help with anxiety, depression, and many other common concerns. We offer psychiatry, therapy, Natural Medicines, and Neuroscience Therapy.
Online care is not a good fit for people with certain conditions or situations. These can include:
1. Ongoing, high-risk self-harm behavior
2. Schizophrenia or any symptoms of psychosis
3. Some cases of bipolar disorder I or acute mania
4. Severe substance use
5. Medically unstable eating disorders
6. Dementia
If any of these describe a condition you’re experiencing, it’s best for you to be seen in person by a primary care provider who can help you find the treatment that’s right for you.
How Care at Neuroscience Psychiatry Works
1. Start with your free Brain Wiring Assessment
Take our quick online assessment to get a snapshot of how your brain and nervous system may be wired. You’ll see your results instantly, and they’ll guide your provider in understanding your starting point.
2. Schedule your comprehensive evaluation
Your first appointment is a deep-dive, not a rushed intake. Depending on your needs, this may include:
* A full psychiatric evaluation
* Optional brain mapping or neuroscience-based testing
* A review of your history, goals, and lifestyle factors
Together, we’ll uncover what’s driving your symptoms and create a plan that fits you—not just a prescription.
3. Get your personalized recommendations
Based on your evaluation, your provider may recommend:
* Psychiatry and medication management (when helpful)
* Therapy, mindfulness, or clinical hypnotherapy
* Natural medicine options for mood, sleep, and focus
* Neuroscience therapies like brain mapping, neurostimulation, or TMS
You’ll know exactly why each recommendation was made, and how it supports your brain and body.
4. Follow your plan, with ongoing support
Care doesn’t stop after your first visit. You’ll meet with your provider regularly to track progress, fine-tune your plan, and celebrate wins. Between sessions, you’ll have access to check-ins, guided tools, and self-tracking exercises to help you stay on course.
5. Track your progress and evolve
We measure what matters—your real improvements. With ongoing feedback, your provider adjusts your care so you continue moving toward balance, focus, and resilience.
Who are the providers and therapists?
Our expert providers are handpicked for their ability to provide best-in-class mental health care. They have years of experience and active licenses in your state.
All of our therapists have:
1. A master’s or doctorate degree in clinical psychology, clinical social work, or counseling from an accredited program
2. Experience delivering science-backed (also known as evidence-based) care for anxiety & depression
All of our psychiatric providers are:
1. Psychiatrists or psychiatric-mental health nurse practitioners (PMHNPs)
2. Exceptionally skilled at prescribing effective medication
Every provider in our network goes through a rigorous hiring and vetting process that you can learn more about here. They also follow the same high clinical standards as in-person providers.
Do you take insurance?
Yes, learn more about insurance we accept here.
Is my information kept private?
Neuroscience Pscyhiatry and its associated platform is HIPAA compliant and follows all HIPAA requirements including, but not limited to, the Privacy Rule. We encrypt data in transit and at rest. All communication with our software is done using signatures with a cryptographic hash algorithm. As well, all information is encrypted at rest once stored on our servers.
Why do you need to monitor my symptoms?
Mental health conditions are complicated. To make sure you are on the right treatment, and making appropriate progress, we will ask you to complete check-ins periodically to let us know how you’re doing. Your provider will review these check-ins to help them decide whether making an adjustment will help you get better, faster, and stay that way longer. You can also use this information to track your own progress over time.
How do I get my medication?
If prescribed, your psychiatric provider can send your prescription to a local pharmacy for your convenience.
How can I get help if I’m in crisis?
Your safety is extremely important to us. If you’re at immediate risk of suicide or self-harm, seek 24/7 help now:
1. Call or text 988 for the 988 Lifeline.
2. Call 911 for emergency support.
3. Go to your local hospital immediately for care.
Help is always available. We also recommend reaching out to a family member or friend to let them know that you are having these thoughts and to ask for help and support.
What do you treat?
Our expert providers can help with anxiety, depression, panic, suicidal thoughts, and many other common concerns, including:
1. Generalized anxiety disorder
2. Major depressive disorder
3. Panic disorder
4. Phobia
5. Social anxiety disorder
6. Obsessive compulsive disorder (OCD)
7. Post-traumatic stress disorder (PTSD)
8. Seasonal affective disorder (SAD)
9. Postpartum depression
10. Premenstrual dysphoric disorder (PMDD)
11. Insomnia
12. Bipolar disorder
13. And more
We’re committed to delivering life-changing depression, anxiety, and trauma care to everyone who needs it.
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