Video Consent

Live Observation/Consent to Video Tape

In order to effectively train therapists and provide the best possible therapy treatment, it is common for supervisors and other therapists or therapists-in-training to watch a therapy session through a video or audio tape recorder. At times, the supervisor may even communicate with the therapist during the session in order to enhance the effectiveness of the therapy treatment. In order for a supervisor, therapist or a therapist-in-training to observe a session, clients must give written consent.

By signing below, I give my consent to allow my therapy session at Wellness and Relationship Counseling, P.A. to be observed through videotape, taped by my therapist, Maureen DeLorenzo, LCSW.

I understand that any supervisor, therapist, or therapist-in-training who observes my therapy session is under the same confidentiality requirements as my therapist. Furthermore, I understand that if by change a supervisor, therapist or therapist-in-training knows me socially, he/she will immediately leave the session and will not observe, seek or be given any information about my case.

I also understand that the purpose of allowing observation of my therapy sessions is to enhance the training of my therapist and enhances the effectiveness of the therapy treatment I am receiving. I understand that I may withdraw this consent at any time.

Furthermore, I understand that while being treated at Wellness and Relationship Counseling, P.A. my primary therapist will remain Maureen DeLorenzo, LCSW and that in the case of emergency or problems during the week, I will contact her at (561) 306-1499.