Workplace Wellness Therapy Session Observation Consent Form

Workplace Wellness Therapy Session Observation Consent Form
Please complete this form to provide your consent for observation during a workplace wellness therapy session. All information will be handled respectfully and confidentially.
Participant Full Name
First NameLast Name
Observer Full Name
First NameLast Name
Organization/Company Name
Participant Email Address
example@example.com
Session Date
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Session Location
Purpose of Observation
Preferred Method of Contact (if follow-up is needed)
Additional Comments or Special Considerations
Should be Empty: