I/We Full Name(s)* consent to the video and audio taping of therapy sessions with our therapist. I/We are aware of the presence of the video equipment and permit the use of all or part of the videotapes and audio recordings for the purposes outlined below. By initialing by each use, we are granting our permission for our therapist to create recordings of our sessions for that purpose.Initial Here* Our therapist's review to assist us in our therapy. Initial Here* Our therapist's consultation with a clinical supervisor(s) and/or supervision group to assist us in our therapy. Initial Here* This tape may be securely sent to the International Centre for Excellence in Emotionally Focused Therapy (ICEEFT) in application for certification as an EFT Therapist.Initial Here* We realize no information about us as a couple/family or any part of a recording (audio or video) will be shared with anyone (supervisor or trainee) that knows us personally. All supervisors and trainees are therapists who agree to this stipulation about our private therapy information.In no way will the refusal to grant consent for this video taping effect my/our getting assistance for myself/ourselves. If at any time during the treatment process, we wish to stop the taping we may do so and still continue treatment.I also understand video and audio recordings are NOT part of a permanent record. Your therapist reserves full rights to the tapes and can destroy or delete them at any time, and his or her discretion.