Serenity Behavioral Health Services provides continued teaching and training for our therapists. Because of this, permission is occasionally requested of their clients to video record a session so their clinical supervisor can provide feedback to strengthen their skills. Our therapists cannot record a client session without your written permission; therefore, your therapist is requesting your consent to video record one session with you. Feel free to discuss this or any questions about the purpose of the video recording with your therapist. 

Your signature below indicates that you give {therapistsName} permission to video record your session and that you understand the following:

1. I can request that the video recorder be turned off at any time and I may request that any portion of it be erased. I may terminate this permission to record at any time.
2. The purpose of recording a client session is for your therapist to receive feedback from their supervisor to strengthen their clinical skills and to better help you.
3. The contents of recorded client sessions are confidential and the information will not be shared outside the context of supervision.
4. The recorded client session will be erased after your therapist's next supervision meeting with their clinical supervisor.

By signing below, you are stating that you provide consent to Serenity Behavioral Health Services for {therapistsName} to video record your session.