Giving Permission for Video-Taped EMDR Therapy Sessions

APPLICANT PLEASE READ:

During our sessions at OCHC, it is often very helpful to video-tape therapy sessions with our children for training and supervisory purposes.

Privacy and discretion are of upmost importance in this industry (and to us), so we require therapists to obtain expressed written consent from parents, before any sessions can be video-taped or photographed.

Videos are viewed only by your child’s therapist, trainers, and trainees.

Videos are used to provide guidance and instruction from the trainers to the therapists and students involved in care. Videos will be used to assist current therapist to complete (EDMR) Eye Movement Desensitization and Reprocessing training. EMDR is a trauma focused therapy technique used to desensitize and reprocess difficulty memories and emotions.

If you agree to allow a therapist of Ozarks Community Health Center to video-tape therapy sessions with your child, please fill out the form below.

Consent to Video

Step 1 of 3

Video-Tape EMDR Therapy Sessions

Child's First Name(Required)

Child's Last Name(Required)

Birth Date(Required)

Therapist's Name:(Required)

Parent/Guardian Name:(Required)

First Last

Parent Email:(Required)

Primary Phone:(Required)

Giving Permission for Video-Taped EMDR Therapy Sessions

Consent to Video

Video-Tape EMDR Therapy Sessions

Consent and Agreement

Disclaimer and Signature

Ozarks Resource Group d/b/a Ozarks Community

Health Center has been awarded recognition by

the National Committee for Quality Assurance

as a Patient-Centered Medical Home under

the PCMH 2017 program.