Crisis Intervention Therapy Session Observation Consent Form
Please complete this form to request consent for observing a crisis intervention therapy session. All information collected is for the purpose of session observation consent only. Do not provide sensitive health, medical, or financial details.
Full Name of Observer/Requester
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship or Role in Relation to the Session
*
Please Select
Therapist in Training
Supervisor
Researcher
Program Administrator
Other
Organization or Affiliation
*
Purpose of Observation
*
Requested Session Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observation Setting or Format
*
In-person
Virtual/Online
Other
Consent to Observe and Confirmation (Signature or Typed Name)
*
Submit Consent
Submit Consent
Should be Empty: