This form must be on file in order to participate in Walk & Talk Therapy.
A request for Walk & Talk Therapy (i.e., therapy that takes place outside of the therapy office while walking with said therapist) has been made as part of my and/or my dependent's healing process.
Permission is hereby granted for the client to participate in Walk & Talk Therapy services. I understand that at any point it may be requested to withdraw from Walk & Talk Therapy or to return to the office during the session(s).
I agree that any communication with the therapist mentioned above about being uncomfortable physically or emotionally while participating in Walk & Talk Therapy will be made. If appropriate, I agree to seek a doctor's approval prior to beginning Walk & Talk Therapy. If there are any medical conditions (including allergies, asthma, disabilities, or other known medical or physical restrictions) that could be a concern with regard to Walk & Talk Therapy, they will be disclosed prior and it is understood that the therapist may or may not be able to offer this form of therapy.
I agree that the therapist named above and A Better Way Counseling Services, LLC will not be held financially or legally liable for any reason in the case of client accident, injury, illness, or any other medical condition or adverse occurrence while participating in, or that might arise from, Walk & Talk Therapy. The therapist will exercise reasonable caution to protect you, and/or other dependents, from adverse occurrences. However, in the case emergency medical attention is needed, I give permission to the therapist and/or A Better Way Counseling Service, LLC to call 911 if necessary. I understand that contact with the client’s emergency contact person would be made as soon as possible depending on the circumstances.
Name and phone number of emergency contact while the client is on walking session(s):