Positive Perspective Therapy | Divine Mercy University

 CLIENT PERMISSION FORM

My signature below indicates that I understand counseling services are being rendered to me by Rebecca Pine, a master’s degree candidate under competent supervision, and that all relationships with counselors and supervisory staff will be kept confidential within the limits allowed by ethical guidelines for counselors. I understand that if a session is recorded it is for counselor training purposes and will be kept confidential within the limits allowed by ethical guidelines for counselors. I understand that failure to grant permission to record sessions will not affect my eligibility for services. I also understand that I may withdraw this consent at any time.

PARENT OR GUARDIAN PERMISSION FORM

My signature below indicates that I understand that my son/daughter’s counseling service will be rendered by Rebecca Pine, a master’s degree candidate under competent supervision, and that all relationships with the counselors and the supervisory staff will be kept confidential within the limits allowed by ethical guidelines for counselors. I understand that the recording of any sessions are for counselor training purposes and will be kept confidential within the limits allowed by ethical guidelines for counselors. I understand that failure to grant permission to record my son/daughter’s sessions will not affect my child’s eligibility for services. I also understand that I may withdraw this consent at any time.