Anger Management Therapy Session Observation Consent Form
Please complete this form to provide consent for observation during your anger management therapy session.
Participant Full Name
*
First Name
Last Name
Participant Email Address
*
example@example.com
Participant Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Observer Full Name
*
First Name
Last Name
Observer Relationship to Participant
*
Please Select
Parent/Guardian
Spouse/Partner
Friend
Therapist-in-training
Other
Session Date and Time
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Purpose of Observation
*
Please Select
Training/Education
Supervision
Family Support
Other
Do you have any concerns about being observed during your session?
*
No, I have no concerns.
Yes, I have concerns (please describe below).
If you have concerns, please describe them here:
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Participant Signature
*
Submit Consent
Submit Consent
Should be Empty: