This consent is to give permission for an observer to be in present the room during your counseling session for educational purposes only.
Participation is voluntary Participation in this study is completely voluntary. If you decide that you will participate, we will ask you to sign the form.
Statement of Consent
i. I have read the content of this consent form and agree on behalf of this facility to observation participation.
ii. I have had the opportunity to ask questions, and all have been answered to my satisfaction.
iii. I have been given sufficient time to consider the above information and to seek advice if I so choose.
iv. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my medical care or legal rights being affected.
v. I understand that relevant sections of my health will be discussed during the observation, and I give permission to these individuals to observe my therapy session.
I hereby release K&G Counseling and Consulting, its staff, employees, agents and representatives from any liability, injury or damages caused by or arising from or in connection with my presence as an observer in the office.
By signing the consent form, I have not given up any of my legal rights.