Client Consent Form

Effective date: August 17, 2026.

Purpose of this form

Your clinician uses an app called NoteWrite to help document your sessions together. This form explains how that works, what happens to information from your sessions, and asks for your consent before your clinician uses it in connection with your care. You are free to ask your clinician questions about any part of this before deciding, and your decision does not affect the care you receive (see "Your choice," below).

What NoteWrite does

During or after a session, your clinician may use NoteWrite to:

• Record what's said during the session (with your consent, given separately for each session), or dictate a summary afterward, or scan handwritten notes your clinician took by hand.
• Convert that into text, using speech-recognition or scanning technology that runs directly on your clinician's device — your voice or handwriting is not sent anywhere for this step.
• Organize that text into a structured clinical note, using an AI service to help draft the note in your clinician's standard documentation format.
• Let your clinician review, edit, and correct the note before it becomes part of your official record. Nothing is finalized without your clinician's review and sign-off.

What information leaves your clinician's device

Only the minimum needed to draft the note. Specifically:

• You are identified in the app by initials and an internal ID only — never your full name.
• The text sent to the AI service is limited to the clinical content needed to draft your note (e.g., what was discussed, interventions used, plan for next steps) — not the raw audio recording, and not a scanned image of any handwritten page.
• Information about suicidal ideation, homicidal ideation, self-harm, or safety planning is never sent to the AI, in either direction. It is handled entirely separately by your clinician, the same way it would be without this app.
• The AI service (Amazon Web Services' Bedrock, using an Anthropic Claude model) does not retain this text after your note is drafted — it processes the request and does not keep a copy.

Your clinician remains responsible for your record

AI-drafted text can be incomplete or occasionally inaccurate. Your clinician reviews every AI-assisted note before it becomes part of your record, and is responsible for its accuracy — the same clinical judgment and professional responsibility applies to a NoteWrite-assisted note as to any note your clinician writes by hand.

Your choice

Using NoteWrite for your sessions is optional. You may decline, and your clinician can document your sessions the traditional way instead — by hand or by typing notes directly, with nothing sent to any AI service. Declining does not affect the quality of care you receive or your relationship with your clinician. You may also change your mind at any time, for any future session, without needing to explain why. It your responsibility to let the clinician know are the beginning of each session.

Questions

You can ask your clinician any question about this form or about NoteWrite before signing. Your clinician can also direct you to NoteWrite's Privacy Policy for more technical detail about how information is handled.

Consent

By signing below, I confirm that:

• I have read (or had explained to me) the information above.
• I understand that my clinician may use NoteWrite — including recording or dictating session content, or scanning handwritten notes — to help draft my clinical documentation, and that a limited, de-identified portion of that content may be processed by a third-party AI service as described above.
• I understand that safety-related information (suicidal ideation, self-harm, and similar) is never sent to the AI.
• I understand that using NoteWrite for my sessions is optional, and that declining does not affect my care.
• I consent to my clinician's use of NoteWrite in documenting my care, on the terms described in this form.