Substance Recovery Therapy Session Observation Consent Form
Please complete this form to provide your consent for observation during the substance recovery therapy session.
Full Name of Participant
*
First Name
Last Name
Participant Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Session
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observer's Full Name
*
First Name
Last Name
Observer's Relationship to Participant
*
Please Select
Family Member
Therapist
Case Worker
Program Staff
External Evaluator
Other
Purpose of Observation
*
Training
Evaluation
Family Support
Program Assessment
Other
Session Location
*
Additional Comments or Special Instructions
Submit Consent
Should be Empty: