CONSENT AND RELEASE OF LIABILITY FOR ANIMAL ASSISTED THERAPY
Therapy animals can be a vital part of the treatment team; I hope that you are comfortable with Jessie’s presence in your sessions. However, because she 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 insure Jessie’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 diligent warning about the potential harm that could be present when working with animals.
While I have listed some of these risks below, we cannot foresee all potential problems that may occur. Therefore by signing this form you are releasing Erin Patterson, MA Ed S, LCMHC-S from any liability should any injury occur as part of your treatment at Patterson Psych Group.
- Jessie 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 for the duration of your session. Please do not feel obligated to have her participate; she loves her crate!
- 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. When playing with a toy with Jessie, she may miss the toy and get your finger. When she realizes this, she releases and does not bite down, but you may still feel her teeth.
- While Jessie 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. Jessie is up to date on all of her vaccinations.
- Jessie is NOT considered a “hypoallergenic” dog, therefore there is risk for allergic reaction. Please let me know if you typically have allergies to animals.
- Animals have individual rights, just as each client has rights. Therefore, Jessie 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.
- Jessie 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.
- Jessie 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.
- Jessie will always need me present in any therapeutic situation.
- If Jessie 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.
- Jessie can only be carried by her therapist handler.
- Because of the unpredictability of animals in unfamiliar situations, clients may not bring their own animal to be involved in their therapy session.
- Jessie will be crated for any sessions involving children under the age of 13 and any adolescents with smaller frames regardless of age.
By signing below you are stating your acceptance of these rules and risks and agree to accept full liability in the event that Jessie 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 being on the property of 1554-C Union Road, Gastonia NC 28054 or at any other place while in the presence of Erin Patterson, MA EdS, LCMHC-S and Jessie.
Jessie, or Jessica when she is in trouble, is a 2 year old lab/pit mix who was rescued from a less-than-ideal situation at 5-weeks old. She has come to work at Patterson Psych Group almost every day since.
She is well-behaved, but energetic. She is loving and curious and honestly sleeps most of the day. Occasionally on the couch or on the back of the couch.
Please see the information below if you are considering seeing Erin for therapy. This consent will need to be signed prior to sessions and includes risks and rules regarding having Jessie join sessions.
Patterson Psych Group, PLLC
Help for today, Hope for tomorrow