All graduate students or licensure candidates at Denver Affordable Counseling are required to be under the direct supervision of a qualified clinical supervisor. Supervisors review all aspects of the services we are providing to you. Your signature confirms you have read and understand the following:
I am not required and I am under no obligation to have this session recorded.
I may withdraw my permission at any time.
My care will not be affected by my decision to be recorded / not be recorded.
The contents of this recording will only be accessible by my therapist, a treatment team including; supervisors and interns at Denver Affordable Counseling and school supervisors.
This recording will only be used as a tool to aid in more accurate supervision and training of the counseling intern or licensure candidate.
The confidentiality of this recording will be maintained under the same guidelines as the content of a non-recorded session as stated in the HIPAA agreement.
The original copy of this consent form, as well as any written requests for revocation of consent, will be kept in my records.
This consent expires in one year. Although, I may revoke this consent at any time prior to the scheduled expiration by submitting a request in writing to my therapist or the clinical director at Denver Affordable Counseling.
By completing this form, I give my consent to allow my therapist to record our session(s) for learning and supervision purposes only.
