Controlled Drinking Group Informed Consent

Welcome. This page is for approved participants to review and sign the informed consent for our therapist-led harm reduction moderation group. Please review all policies carefully before proceeding to sign below.

Nature and Purpose

The Controlled Drinking group is a therapist-led harm reduction initiative designed to provide a supportive, nonjudgmental environment for individuals exploring moderation. Our focus is on enhancing quality of life through mindful consumption strategies and evidence-based psychological tools.

Confidentiality and Limits

Your privacy is paramount. Information shared within the group is kept confidential by the therapist, except where required by law (e.g., risk of harm to self or others, child or elder abuse). Participants are also expected to uphold mutual confidentiality to maintain the group’s psychological safety.

Risks and Benefits

Participation may lead to improved mental wellness and greater personal agency. However, discussing sensitive topics can involve emotional discomfort. Harm reduction is a customized journey, and results depend on consistent engagement with the group process and clinical strategies.

Rights and Participation

Participation in the Controlled Drinking Group is entirely voluntary. You may discontinue participation at any time and may cancel your membership to prevent future monthly charges. Cancellation does not provide a refund for the current billing period. We encourage open communication with the therapist regarding your needs, and you may seek alternative forms of support at any time.

Member Expectations

We expect all members to treat one another with dignity and respect. Active listening, punctuality, and a commitment to the nonjudgmental ethos of Controlled Drinking are essential. By participating, you agree to protect the identity and personal information of all fellow group members.

Telehealth & Emergency

Participation in our therapist-led harm reduction group takes place via secure Zoom sessions. To ensure the safety and privacy of all members, participants are expected to join from a strictly private, quiet environment where they will not be overheard or interrupted by household members.

Maintain a stable internet connection and keep cameras on throughout the session to facilitate clinical engagement. The recording of any group session by participants is strictly prohibited, maintaining the sanctity of our shared digital space.

Crisis Support Notice

Please be advised that this moderation group is not a form of emergency or crisis care. In the event of a mental health emergency, clinical crisis, or immediate danger to yourself or others, please contact 911 or your local emergency services immediately, or reach out to a 24/7 crisis hotline.

Financial Agreement

Monthly Membership Fees

The Controlled Drinking Group is offered as an ongoing monthly membership for $200 per month. Membership includes access to the weekly 90-minute Sunday 7:00 PM Pacific Time group and reserves your place in the group, which is limited to 12 active members. The membership automatically renews each month until canceled.

Membership and Attendance Policy

Membership in the Controlled Drinking Group is $200 per month, billed on a recurring monthly basis until canceled. The monthly membership fee reserves your place in the group and is not based on the number of sessions you attend.

There are no refunds, credits, prorated fees, or make-up sessions for meetings you choose not to attend. Your $200 monthly membership fee remains the same regardless of attendance.

You may cancel your membership to prevent future monthly charges. Cancellation does not provide a refund for a billing period that has already begun.

Consent Acknowledgment & Signature Form

Participant's full name

Date

Group Nature and Purpose — I understand that this group is a structured, professionally facilitated program focused on controlled drinking strategies. I have been informed of the group's goals, format, session frequency, and duration.

Confidentiality and Its Limits — I understand that information shared within individual sessions is kept confidential, except where disclosure is required by law (e.g., imminent risk of harm to self or others, suspected child or elder abuse, or court order).

Risks and Benefits — I acknowledge that participation may involve discussing sensitive topics related to alcohol use, which may cause temporary emotional discomfort. I understand that potential benefits include developing healthier drinking patterns and improved self-regulation skills, and that outcomes are not guaranteed.

Voluntary Participation — I confirm that my participation in this group is entirely voluntary. I have not been coerced or pressured to participate, and I understand I may withdraw at any time without penalty or loss of services.

Group Confidentiality Expectations — I agree to maintain the confidentiality of all other group members. I will not disclose the identity, statements, or personal information of any participant outside of the group setting. I understand that the facilitator cannot guarantee the confidentiality of other members.

Telehealth — If sessions are conducted via telehealth, I understand the associated limitations and risks, including potential technology failures and reduced ability to respond to emergencies. I agree to provide a local emergency contact and confirm my physical location at the start of each remote session.

Membership, Attendance & Cancellation — I understand that membership is $200 per month, billed until canceled, and the monthly fee is due regardless of attendance. There are no refunds, credits, prorated fees, or make-up sessions for missed meetings.

Enter full name as electronic signature