AI Consent Addendum for Therapy: Template and Guide

Why an AI Addendum Is Separate From Your Main Consent

Your informed consent document tells clients how therapy works, what it costs, and when confidentiality has limits. AI documentation tools add a new party to the record-keeping process: a software vendor that receives session content. Clients cannot weigh that unless you tell them, in plain terms, what the tool does with their words.

A separate addendum works better than a new paragraph in your main consent for three reasons. You can change tools without re-papering every client. Clients can say yes or no to AI use without that choice getting tangled with consent to treatment. And the signed addendum shows the client made a specific decision about AI, not a general one.

This page gives you an original template written for that purpose. It is not built on any vendor's or published form's structure. Adapt it to the actual tool you use.

Two Very Different Kinds of AI Tool

The single most important thing the addendum must do is say which kind of tool you use. They create very different privacy exposure.

	Ambient AI scribe	Clinician-entered AI drafting
What it captures	Audio of the session (in person or telehealth), usually turned into a transcript	Only what you type or dictate after the session
Who it hears	Everyone in the room or on the call	Only you
What the vendor receives	Session audio and/or transcript	Your summary of the session
Consent focus	Permission to record, from every participant	Disclosure that a third-party tool helps draft notes

Some products offer both modes. If yours does, the addendum should say which mode you will use with this client.

The AI tools landscape is covered in more detail in our guide to AI tools for therapists.

What the Ethics Codes and HIPAA Say

Recording requires permission. APA Standard 4.03 says psychologists, "before recording the voices or images of individuals to whom they provide services," must "obtain permission from all such persons or their legal representatives." NASW Standard 1.03(h) says social workers "should obtain clients' informed consent before making audio or video recordings of clients." An ambient scribe records, so these standards apply.

Technology use should be discussed. NASW Standard 1.03(e) asks social workers to "discuss with clients the social workers' policies concerning the use of technology in the provision of professional services." That covers clinician-entered AI tools too.

Multi-person sessions need clarity at the outset. APA Standard 10.02 asks psychologists in couples and family work to clarify at the start who the clients are, and Standard 10.03 asks group therapists to describe at the outset "the roles and responsibilities of all parties and the limits of confidentiality."

Minors and others who cannot consent. APA Standard 3.10(b) asks psychologists to give an appropriate explanation, seek the individual's assent, consider their preferences and best interests, and get permission from a legally authorized person where the law allows or requires it.

Client consent does not replace a vendor agreement. Under HIPAA, a vendor that "creates, receives, maintains, or transmits protected health information" for you is a business associate (45 CFR 160.103). Before you share that information, 45 CFR 164.502(e) requires satisfactory assurance that the vendor will safeguard it, documented in a contract that meets 45 CFR 164.504(e). That contract must, among other things, require the vendor to use appropriate safeguards, report unauthorized uses or disclosures (including breaches), bind its subcontractors to the same terms, and return or destroy the information at termination where feasible. Get the BAA first. The client addendum sits on top of it, not in place of it.

Recording laws and professional rules also vary by jurisdiction and license type. For telehealth, that can mean the law where each participant is located, not only where you practice. Some state recording laws, such as Washington's RCW 9.73.030, require the consent of all participants and reach transmission as well as recording, so a tool that transcribes live without keeping audio still needs that assessment. Check the applicable recording laws and your licensing board's position before relying on any template.

Consent here is mostly ethics and good practice, not a HIPAA form. HHS explains that HIPAA permits, but does not require, consent for ordinary treatment, payment, and operations uses. The duty to discuss recording and technology comes from the ethics codes and state law. The separate, opt-in, no-penalty addendum on this page is a recommended practice policy that meets those duties clearly. It is not a form HIPAA itself mandates.

Psychotherapy notes are a separate category. Under 45 CFR 164.508(a)(2), most uses and disclosures of HIPAA psychotherapy notes, the separately kept process notes described in our psychotherapy notes vs. progress notes guide, require a specific authorization. This addendum is not that authorization, and a BAA does not change that. Limit what you enter into the tool to information for routine clinical documentation, and assess any use involving psychotherapy notes separately.

What the Addendum Should Cover

1. The tool and the mode. Name the product and say whether it records the session or works only from your own notes.
2. What is captured. Audio, transcript, your typed notes, or a combination.
3. Where the data goes. The vendor's name, whether processing happens on the vendor's servers, and whether a BAA is in place.
4. Retention and deletion. How long audio, transcripts, and drafts are kept by the vendor, and that the final note becomes part of your clinical record under your normal record retention policy. Use the figures from your vendor contract, not a guess. Cover this for every input, including your typed or dictated summaries and the generated drafts, not only audio.
5. Secondary use. Whether the vendor may use session content to train or improve its models. If your contract prohibits it, say so. If it does not, disclosure alone is not enough: neither the vendor's terms nor this addendum authorizes a secondary use on its own. A business associate contract cannot permit a use that would be impermissible for you to make yourself (45 CFR 164.504(e)(2)(i)). Before allowing any training use, work out its lawful basis with your attorney, including whether it needs a separate HIPAA authorization or properly de-identified data.
6. Clinician review and risks. That you read, correct, and sign every note, that the AI does not make clinical decisions, and what can go wrong: inaccurate or incomplete drafts, misattributed speakers, and unauthorized access to stored data. APA's guidance on AI in practice calls for communicating the potential benefits and risks of the tools you use.
7. Choice without penalty. That the client can decline or withdraw at any time, for one session or for good, and that their care, fees, and access to you do not change.
8. Other people in the session. For couples, family, and group work, everyone present must agree before recording, and a single "no" means no recording. Record each person's choices separately. If one person accepts AI drafting and another declines, write the shared-session note without the tool unless you can honor the decline another way.
9. Minors. Permission from a parent or legal guardian where the law requires it, plus the minor's own assent, explained at their level. See our minor consent page for jurisdiction issues.

Complete AI Consent Addendum Template

In this example, the fictional client agreed to AI drafting from the clinician's notes but declined recording. The clinician's intake note would say something like: "Reviewed AI documentation addendum. Client declined ambient recording and consented to AI-assisted drafting from clinician-entered notes. Client informed they may change this at any time without effect on care."

How to Put It Into Practice

Step 1: Sign the BAA before anything else. Read the vendor's agreement for retention periods, deletion, subcontractors, and whether session content can be used to train its models. Those answers fill in the template.

Step 2: Fill in the real facts. Replace every placeholder with your actual tool, vendor, and retention periods, and clear both rows of the example's checkboxes before giving the form to a client. If you only use clinician-entered drafting, delete Section A and the recording references in Section C rather than leaving them in. Have an attorney familiar with your jurisdiction review the final version.

Step 3: Offer it as a real choice. Present the addendum separately from the main consent and walk through it out loud. Make declining as easy as agreeing.

Step 4: Re-ask in multi-person sessions. Confirm recording consent with everyone present at the start of each couples, family, or group session, not just at intake.

Step 5: Re-sign when the tool changes. A new vendor, a new mode, or a change in the vendor's retention or training terms means a new addendum.

Common Mistakes

1. Writing "we may use technology" and stopping there. A vague line does not tell the client that a session is being recorded. Name the mode.
2. Treating a client signature as HIPAA compliance. The client addendum and the BAA do different jobs. The BAA is a HIPAA requirement; the addendum meets your ethical and state-law duties and your own opt-in policy. Use both.
3. Recording a group because most members agreed. Every person present must agree to be recorded.
4. Copying vendor marketing claims into the form. Use what your signed contract says about storage, retention, and training, not a product page.
5. Making AI use a condition of care. If a client feels they cannot say no, the consent is not meaningful.