Consent form for Video/Audio Recording

All psychologists have regular supervision with a clinical psychologist, to discuss their work. In order to help the quality of the supervision, I am asking for your permission to video/audio record our sessions. This is so my supervisor and I can talk about ideas and ways of working that might be helpful for you. In addition to this, small parts of the recordings may be transcribed/ written down and used for work towards my training. If this were the case, all names and any factors which may identify you would not be included, so confidentiality would be maintained. All video/audio recordings would be destroyed after the work was completed.

The video/audio would also be available for you to listen to a session again, should you wish.

Please read the following paragraphs and, if you are in agreement, sign where indicated.

1) I /We consent to the sessions being video/audio recorded and these recording being used with the therapist’s supervisor in order to help our work.

Consent for Supervisor to be Present during therapy

All psychologists have regular supervision with a clinical psychologist, to discuss their work. In order to help the quality of the supervision some sessions might be recorded either by video or audio recording device. We regularly supervise students and train therapist and conduct or take part in research. A separate consent will be obtained before recording any of your session or for any mentioned purpose above.

I am aware that I may stop treatment with this mental health professional at any time.

I am aware that if I attempt to contact my provider through phone, email, text, or any other form of communication over the Internet, my information may not be completely secure. In the event that my information is intercepted, KKK Counseling @ Kerala Ayurveda Panchakarma Centre is not responsible for the breach of patient privacy.