Session Recording Consent Form

Purpose

To allow your clinician to be fully present during your session, this clinic uses Wug Note, software that records and documents sessions automatically

Roles & Responsibilities

• Wug Note acts as a service provider to the clinic. The clinic remains responsible for your personal health information under applicable privacy laws.
• If a privacy or security incident occurs affecting your information, the clinic will notify you as required by law.

Data Processing & Storage

The following describes how your data is handled:

1. No AI Training: Your information is never used to train AI models and never exposed to consumer AI services, like ChatGPT.
2. Canadian Storage & Auto-Deletion: Session audio and data are encrypted and stored securely in Montreal, Canada. All audio, transcripts, and AI drafts are automatically deleted after 14 days.
3. Cross-Border Processing: To provide high-quality results, Wug Note uses secure processors in the United States.

• Transcription: HIPAA-compliant service; deletes data within 72 hours.
• Summarization: Enterprise AI service; zero permanent data retention.

Your Rights

• Voluntary Participation: Refusing this service will not impact the quality of care you receive.
• Opt Out Anytime: You may choose to use or decline this tool on a session-by-session basis, and you may ask for the recording to be stopped or deleted at any moment during or after a session.

Consent Statement

I have read and understood the information above, or had it explained to me. I consent to the use of AI-assisted documentation, including the temporary storage of session data in Montreal, Canada, and the temporary transfer of encrypted data to the United States for AI processing.

Client/Guardian Name: _________________________________________________

Signature: _______________________________________ Date: _______________