0. Consentimiento Informado (Atención a Menor de Edad) - EQ Mentores

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Formulario de
Informed consent

Informed consent
[Attention to Minors]

Diligencia este formulario para garantizar la autorización y comprensión como adulto responsable sobre la intervención psicológica del menor de edad. Al enviar este formulario acepto que soy mayor de edad y acepto todos los Terms and Conditions y nuestra Privacy Policy.

1. Names and surnames of the minor *

2. Identification number of the minor and city of issue *

3. Date of birth of the minor (Day/Month/Year) *

(Tell us what motivated you to abandon your process)

4. Address and city of residence of the minor *

(Tell us what motivated you to abandon your process)

5. Names and surnames of the responsible adult *

(Tell us what motivated you to abandon your process)

6. Adult document number and city of issue *

(Tell us what motivated you to abandon your process)

7. Relationship with the minor. Example: Dad, mom, aunt, grandmother, etc. *

(Tell us what motivated you to abandon your process)

8. Cell phone number of the responsible adult *

(Tell us what motivated you to abandon your process)

9. Email (Primary Email) of the responsible adult *

(Tell us what motivated you to abandon your process)

10. Date of birth of the responsible adult (Day/Month/Year) *

(Tell us what motivated you to abandon your process)

11. EQ Mentores is a team of professionals and specialists in Mental Health and Personal Development in Latin America, with a website www.eqmentores.com, led by the psychologist and general director RUBÉN DARÍO ECHAVARRÍA ROJAS with citizenship card number 8,026. 931 of Medellín - Colombia. The Growing Together Network is the line of social action of EQ Mentores. *

I understand

12. PURPOSE OF PSYCHOLOGICAL TREATMENT: Psychological therapy is a therapy commonly used to treat children and adolescents with emotional and behavioral problems. Its goal is to change negative patterns of thinking and behavior, improving emotional management and promoting healthy coping strategies. It also involves working on positive parenting patterns and assertive communication with parents and guardians who must play an active role in stimulating the minor's improvement. *

I agree

13. RISKS OF PSYCHOLOGICAL TREATMENT: Psychological therapy is considered safe, but there may be some minimal risks. Sometimes children and young people may experience uncomfortable emotions when addressing their problems, but the therapist is trained to manage these situations and provide emotional and psychosocial support. It should be noted that these risks are minimal and controllable. *

I understand

14. BENEFITS OF PSYCHOLOGICAL TREATMENT: The benefits of psychological therapy include the reduction of symptoms of anxiety, depression and other emotional disorders, as well as improvement in problem solving and informed decision making. Treatment can help the child develop effective coping skills and improve self-esteem. It can also have a positive impact on interpersonal relationships and school performance. *

I understand

15. ALTERNATIVES OF PSYCHOLOGICAL TREATMENT: There are several alternatives within psychological therapy such as family therapy, group therapy, psychodynamic therapy and play therapy, among others. The treatment approach will depend on the specific needs of the minor and their situation. The therapist will carefully evaluate the case and collaborate with the parents or caregivers to determine the best therapeutic option. *

I agree

16. By filling out and sending this form, you voluntarily agree to join, along with the minor, our professional accompaniment program, until you wish to unsubscribe by notifying the email [email protected] and filling out the Voluntary Withdrawal Form without this does not imply any harm to any of the parties. In addition, you can temporarily suspend the process when there are causes of force majeure, preferably for a maximum of 15 to prevent the results obtained from being lost. You will receive a copy of this document to the email provided for your information and peace of mind. By signing this document you guarantee that the personal data provided are true and you can voluntarily communicate any modification thereof. Likewise, you guarantee that all the information provided for the treatment corresponds to your real and current situation. *

I agree

17. CONFIDENTIALITY AND PRIVACY: All data, medical and psychological records of the minor will be protected according to current laws and our data processing, privacy and confidentiality policy that you will find in the "Secrecy and data security" section, in the page: https://eqmentores.com/politica-de-privacidad/ *

I understand

18. LEGAL FRAMEWORK OF PSYCHOLOGY: Our actions follow the guidelines of the APA (American Psychological Association) and the policies of the Ministry of Social Protection on the provision of services. In Colombia, Law 1090 of 2006 establishes the regulatory framework for the practice of psychology in the country, including the regulation of professional ethics, the creation of the Colombian College of Psychologists and the protection of patients' rights. *

I understand

19. I voluntarily authorize the team of professionals and specialists of Mental Health and Human Development of EQ Mentores and the Red Growing Together on behalf of the psychologist Rubén Darío Echavarría Rojas with identification number 8,026,931 of the city of Medellín, to carry out a process of professional accompaniment to minors through assessment, intervention, monitoring and psychological support in person, virtual or telephone for the time necessary to achieve evident, significant and lasting changes. *

I agree

20. Said process may be suspended at any time, as long as it is informed 3 days in advance to the aforementioned email. *

I understand

21. I also undertake to make the agreed payments on time and supervise compliance with each advice, taking into account the frequency and duration agreed upon from the beginning. Furthermore, I undertake to cancel the appointment, if necessary, with 24 hours notice, otherwise I assume that it will be counted as consultation seen without the right to refund, unless it is a case of emergency or force majeure, which I must demonstrate. . *

I pledge

22. I undertake to send or attach to this file the following documents in physical or digital format (send them to [email protected]): Civil registry of the minor and identification documents of the user and the responsible adult on both sides. *

I pledge

23. I declare that I have read and understood this document, I accept the treatment and attach the copy of the minor's civil registry, his or her identification document and mine to validate the information recorded here. By completing and sending this document I indicate that I agree with the guidelines for approaching and monitoring the professional guidance process, with the aim of restoring emotional balance and improving the mental health of the minor. This agreement is signed, in the city of Envigado-Colombia, on the date of receipt and becomes valid when signing this duly completed form. *

I agree

24. Additional information: (Optional)

(Do you think we should know anything additional? Write it here)

25. I am of legal age and accept all the terms and conditions. *

https://eqmentores.com/aviso-legal/

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