Supervision Handbook

Video/Recording Release

From time to time, sessions may be video or audio recorded so the Associate's supervisor can review clinical work as part of supervision and training. Recordings are used only for this purpose, are kept confidential, and are stored securely.

I understand recordings will be used only for clinical supervision or training and will be kept confidential.

I understand I may decline or withdraw this permission at any time without affecting my (or my child's) care.

I give permission for my (or my child's) session(s) to be recorded for supervision/training purposes. Yes No

Client's printed name Date

Signature of client, or parent/guardian if under 18 Relationship to client (if signing on behalf of a minor)

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