I authorize my clinician to record my therapeutic session(s). My therapist is: Jonobie Ford
I understand that by giving consent to record my therapeutic session(s) I give permission to my therapist to use it for the purpose of:
- supervision and consultation
- training new or developing clinicians
I understand that I am in no way required to grant this authorization, and that I may revoke this authorization at any time by giving written notice to my clinician.
I understand that these authorized recordings will not be maintained, are not intended to become part of my treatment record, and that my clinician will promptly destroy the recordings, or cause the recordings to be destroyed, when they are no longer needed for the purpose specified above.
By signing this document, I attest that I have received, read, fully understand, and consent to the terms and conditions above.