VIG FORM 1
Video Consent Form - Video Interaction Guidance (VIG)
This is to certify that I/we: –
□
Understand the purpose for which my/our consent is being sought to video record
today’s session.
□
Have read the information sheet (below) explaining my/our rights in relation to the
video recordings.
□
Agree to my/our meetings being videoed for the purpose of Video Interaction
Guidance.
□
Agree that the video recording may be watched by the VIG supervisor.
□
Understand that the video recordings will be erased within 2 months of the end of
my/our involvement with Video Interaction Guidance.
□
Am/ are aware that I/we may withdraw consent at any time.
Client Name(s) and Signature(s):
VIG Guider Name and Signature:
Date(s) of session(s) for which DVD/Video recording is sought:
Date and Sign
VIDEO INTERACTION GUIDANCE – INFORMATION SHEET
CLIENTS’ RIGHTS IN RELATION TO VIDEO RECORDING
In asking for your consent to video record the work with you/your family, I agree to:
1.
Explain the purpose for which the video recording will be used and by whom. There
is no intention of including the recording as a permanent part of the medical record,
it is a temporary tool to help as part of a therapeutic intervention.
2.
Ensure that the quality of care being offered is in no way affected by your refusal to
have the meeting(s) video recorded.
3.
Stop the recording at any time during the session if requested to do so by you/your
family.
4.
Guarantee that the recording will be kept safe at all times.
5.
Ensure that no copies of the recording will be made without your written consent.
6.
Erase the recording within 2 months of the end of your involvement with Video
Interaction Guidance, or sooner if requested to do so.