DRAFT OF INFORMED CONSENT
Agency/Practitioner Name
Informed Consent to Record Therapy Sessions via
Electro-Mechanical or Electronic Recordings
I am requesting your permission to record our therapy session or sessions either by electro-mechanical or electronic recordings. The purpose of this recording is to help me serve you better and to review and evaluate my therapy techniques. No recording will be done without your prior knowledge and consent.
All viewers of the electro-mechanical or electronic recording, including myself, are bound by the ethical standards of the American Association for Marriage and Family Therapy or the National Board for Certified Counselors and the American Counseling Association, as applicable.
This consent expires 365 days after the date of your signature below.
The original copy of this consent form will be kept in your records with this agency.
By signing below, you are stating that you have read and understood the Informed Consent to Record Therapy Sessions via Electro-Mechanical or Electronic Recordings and that you are permitting (Agency/Practitioner Name) to audio or video record our session(s).
____________________________
Name of Client (Please print)
____________________________
Signature Date
Nev. Admin. Code § 641A.Sec. 1
NRS 641A.160, 641A.297