At Therapy West, Inc., therapists videotape or photograph children who receive therapy services to help monitor and document a child’s areas of concern, as well as measure their progress. Videotapes and photos are used and reviewed by Therapy West, Inc. staff and occasionally may be used in research projects focusing on outcome measures.
Therapists are frequently asked to participate in research and teach at professional courses, seminars or workshops nationally and internationally, as well as to write articles or chapters in technical books. We often include videotapes, slides or photos during our presentations. If photos or videos are used for any of the above mentioned purposes, they will not have identifiable information. Parents are always welcome to view their child’s videotape at Therapy West, Inc.
Therapy West, Inc maintains a brochure, website, Facebook page and Instagram page. Please mark your consent for staff and therapists at Therapy West, Inc to take photographs and videos of my child for the purpose of posting on these sites. With this consent, I hereby release and discharge Therapy West, Inc from any and all claims arising out of use of the photos and videos. This consent can be changed and revoked by parent at any time.
Therapy West, Inc. uses an encryption service when sending emails with PHI (personal health information) in order to protect me/my child’s PHI in compliance with recommended HIPAA regulations.
Please read the following statements, choose appropriate box, and sign below.
If at any time you would like to start receiving encrypted emails or decline encrypted emails, please contact Therapy West, Inc. at (310) 337-7115 and let us know. You will need to fill out and sign an updated form. Thank you.
The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which Therapy West, Inc (the "Organization") adheres to comply.
By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old, am the legal guardian of the child and fully competent to give my consent; that I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation.
This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.