{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

Form16 - [FORM 16-Use the top of this page for your...

Info icon This preview shows pages 1–2. Sign up to view the full content.

View Full Document Right Arrow Icon
[ FORM 16 —Use the top of this page for your letterhead.] Release and Permission to Record Sessions and to Use Case Materials As a therapist, I naturally want to know more about how therapy helps people. To understand therapy better, I must collect information about clients before, during, and after therapy. Therefore, I am asking you to help by allowing me to record our sessions, and also perhaps by filling out some questionnaires about different parts of your life—relation- ships, changes, concerns, attitudes, and other areas. Video and audio recordings are sometimes used as aids in the therapy process, in the education of mental health professionals, and in research. I need to have your written permis- sion to make and use these recordings and materials for these purposes. I would also be grateful for your consent to use your case material in my other professional activities. Your mate- rial may help in the development of the mental health field or in the training of health care workers. It is possible that I could use your material in teaching, supervision, consultation with other therapists, publishing, or scientific research. For these purposes, I might use any of the following: n Clinical or case notes I or other professionals have taken during or after our sessions. n Psychological test responses and scores, questionnaires, checklists, and similar data collection forms. n Electronic or other recordings (such as audio and/or video recordings, transcriptions, case notes, physiological monitoring, or any other recording method) of any interview, examination, or treatment with me, my employ- ees, or other professionals. These recordings may include clients, therapists, or others, and may be made in my
Image of page 1

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 2
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern