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If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

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The Confidentiality Note should contain a statement indicating that the email is confidential and intended for the named recipient, as well as a process for communicating with the sender in the event the email is received by someone other than the recipient.
Examples of confidential information are: Medical information. Names, dates of birth, addresses, contact details (of staff, clients, patients, pupils, etcetera). Personal bank details and credit card information.
WHAT IS CLIENT CONFIDENTIALITY? Confidentiality includes not just the contents of therapy, but often the fact that a client is in therapy. For example, it is common that therapists will not acknowledge their clients if they run into them outside of therapy in an effort to protect client confidentiality.
Only disclose a client's private information with their consent or when there is a compelling legal or ethical reason to do so. If you do need to disclose confidential information, only reveal the essential information that's relevant to the situation.
I cannot and will not tell anyone else what you have told me, or even that you are in therapy with me without your prior permission. You can authorize me to share information with whomever you choose, and you may change your mind and revoke that permission at anytime.