Outdoor Therapy Consent

I have requested outdoor therapy (i.e. a therapy session that takes place outside of the therapy office while meeting with my therapist through Rogue River Counseling) as part of my healing process.

By signing this form, I agree to the following:

• I understand that if my therapist and I come into contact with a person that I know, I have the right to disclose or not to disclose that I am in a therapy session. I understand that my therapist will follow my lead should we come into contact with a person I know and my therapist will make every effort to preserve client confidentiality and privacy while conducting my walk/talk therapy session.
• I understand that if my therapist should come into contact with a person he/she knows, my therapist will not acknowledge me as a client or the outdoor therapy session as counseling to preserve confidentiality.

Should we decide to walk together during the therapy session:

• I agree that I am responsible for setting the walking pace of the walk/talk session.
• I agree to communicate with my therapist if I am uncomfortable physically or emotionally while participating in therapy while walking.
• I take full responsibility for my medical and physical well-being and will not hold Rogue River Counseling legally or financially responsible for any medical conditions and/or accidents that may arise out of walking together during outdoor therapy.
• I agree to seek a doctor’s approval before walking during outdoor therapy, if appropriate.
• If I have any medical conditions that would be detrimental to walking during outdoor therapy I agree to disclose this and understand my therapist may not be able to offer this as an option.