Consent to Audio Recording by Clinician

InMindOut Emotional Wellness Center, LLC is committed to the education and training of clinicians in
mental health. As such, we are continuing to find ways to improve our supervision and training. One
way to do this is to audio record therapy sessions to assist in supervision of clinicians and to ensure best
quality of services.


  • I consent to be audio recorded for the purposes of supervision, training, and education of
  • I understand that the audio recording(s) of sessions are to be used for training and education
    purposes only.
  • I understand that I can terminate this agreement at anytime.


If client is a minor, please have the parent or legal guardian sign this form.


Leave this empty:

InMindOut Emotional Wellness Center
Signature Certificate
Document name: Consent to Audio Recording by Clinician
Unique Document ID: 371892946f8b9f002bfbe8a7ce63f0e7a0ccbd6d
Timestamp Audit
October 17, 2017 2:55 pm CDTConsent to Audio Recording by Clinician Uploaded by imo imo - IP
January 15, 2018 10:08 am CDT Document owner has handed over this document to 2018-01-15 10:08:09 -