Animal Assisted Therapy

Please select one or both of the options below

Outdoor therapy may be utilized as a form of therapy that may involve sitting outdoors or walking therapy. There will be multiple options of locations to engage in outdoor therapy but will need to be agreed upon by both the client and therapist well in advance. Additionally, outdoor therapy is weather permitting and location may need to be changed to Telehealth or in-office sessions in extreme weather conditions.

Please check each box acknowledging that you have read and understand the following risks to outdoor therapy. Please also note that other risks not listed below may occur*

Accidental injuries that could occur from tripping, falling, or being struck by a car or bicyclistOther physical dangers/risks including insect bites/stings, animal bites, falling branches, sunburn, and exposure to heatAdverse weather conditions such as heat, rain, hail, and/or thunder and lighteningConfidentiality considerations: complete confidentiality cannot be guaranteed. Every attempt will be made to not engage in private conversations when others are in close proximity but it is impossible to guarantee conversations will not be heard by othersIt is also possible that the therapist or client could come into contact with someone known to either party. If this occurs the therapist will not disclose that you are a client or any other confidential informationGiven todays use of technology it is possible that you could be photographed or videoed with your therapist without knowing

Animal therapy may be an additional form of treatment utilized. Animals may be able to provide comfort, while in some cases also be able to reduce stress, anxiety, depression, and PTSD symptoms. However, because Lyra is an animal, and not a human, we are responsible for her welfare. In addition, because she is an animal, her behavior cannot always be predictable. Therefore, it is important to discuss in advance the risks and rules needed to ensure Lyra’s and your safety and health and try to create as safe a working situation as possible. In addition, it is important to provide you with a diligent warning about the potential harm that could be present when working with animals.

Please check each box acknowledging that you have read and understand the following risks to animal assisted therapy. Please also note that other risks not listed below may occur

Lyra is currently in training; meaning she has not yet been certified to do Animal Assisted Therapy. She still needs to learn some skills to pass her certification test. During her training process, and even once she is certified, you may opt to not have her a part of your session. Should you choose, she will stay in her crate or at home for the duration of your session. Please do not feel obligated to have her participate.Animals have their own natural defenses. While I will do everything possible to prevent any injury, it is possible that someone will get scratched or bitten.Animals often use their mouths in play. Therefore, even when playing, it is possible for light biting to occur.While Lyra has been screened by a veterinarian before commencing to work as a therapy animal, animals do sometimes carry disease. Because your contact is minimal, this risk is very small. Lyra is up to date on all her vaccinations.Lyra is NOT hypoallergenic and will likely shed. People who have dog allergies or sensitivities to animal fur or dander should keep this in mind.

Please check each box acknowledging that you have read and understand the following rules of animal assisted therapy. Please also note that other risks not listed below may occur

Animals have individual rights, just as each client has rights. Therefore, Lyra is allowed to determine if and when she participates with others. While it may be planned to have her in session, she will never be forced to do so.Lyra has her own quiet space in the office where she can rest, sleep, or just take a quiet break. She should not be disturbed when she is in this area.Lyra should always be treated gently. She should never be hit, have her tail or any other parts pulled, be carried, or treated in any other way that is uncomfortable to her.Lyra will always need me present in any therapeutic situation and can only be walked by myself.If Lyra becomes irritated, scared, or in any way acts in a negative manner, I will put her in a safe place. No other person should touch her at these times.Because of the unpredictability of animals in unfamiliar situations, clients may not bring their own animals to be involved in their therapy session.

By signing below, you indicate that you understand and accept the risks of outdoor therapy outlined above, including the potential risk of exposure to COVID-19. This consent can be withdrawn at any time in writing.

Outdoor therapy may feel like more of a social interaction than a therapeutic interaction. Despite the shift in how therapy will be conducted the relationship between the client and therapist continues to be entirely professional and not a social relationship

You are choosing to engage in outdoor therapy completely voluntarily

You agree to obtain approval from your doctor before engaging in outdoor therapy if you have a medical condition that may affect your ability to participate safely. Additionally, you will disclose this information to your therapist

You will take full responsibility for your physical safety and not engage in activities that make you feel unsafe

You agree to let your therapist know if you become uncomfortable either physically or emotionally during outdoor therapy

While I have listed some of these risks below, we cannot foresee all potential problems that may occur. You are stating your acceptance of these rules and risks and agree to accept full liability in the event that Lyra harms you or your child in any way in the course of treatment or you or your child is harmed in any way as a result of choosing to engage in animal therapy either in-office sessions or during outdoor therapy. Additionally, I am agreeing to voluntarily engage in animal therapy with Lyra. By signing this form you are releasing Aware Mental Wellness and Emilie Moreau, MA, from any liability should any injury occur as part of your treatment.

Client's Name*

First NameLast Name

Client Signature*

Clear

Date*

Date

Parent/Guardian Name if Client is Under 18

First NameLast Name

Parent/Guardian Signature if Client is Under 18

Clear

Additions to Treatment

Outdoor Therapy Consent Form

Animal Assisted Therapy