My signature below gives permission for my therapist (named above) to video or audio record therapy session(s) with me.
I understand that my therapist is either a counselor-in-training at a Master's Level program within a University/College, and is doing their internship at A Better Way Counseling Service, or is a Licensed Mental Health Counselor Associate receiving supervision in order to become fully licensed. I understand that they are completing clinical requirements to make audio and/or video tape recordings of counseling session(s).
I understand that these recordings will be used only for the purpose of providing clinical supervision at A Better Way Counseling to the counselor-in-training. I will be notified by my therapist at the beginning of any session that will be recorded.
Any person involved in providing or receiving clinical supervision is bound to the same ethical principle of confidentiality as professionals providing counseling. All recordings of counseling sessions will be kept in a HIPPA-compliant system and will be erased no later than the end of the present academic semester. Any exception to this last statement would require an additional permission form to be signed by the client and counselor.
I understand that my signature and permission to record sessions are not required to be able to continue therapy with this counselor.
My signature below indicates I have had a discussion with my therapist about session recordings, and had an opportunity to ask any questions I may have.