I agree to adhere to the following norms and expectations of the Muhsen Caregiver Support group:
∙ I will not discuss anything shared in group with others outside of the group.
∙ I will be respectful of others’ thoughts, emotions, and behavior.
It is essential that members know that whatever they say or how they act in the group remains in the group and that members will not discuss these things with anyone outside the group. I understand that this is the best way to create a safe and inclusive space and where members can trust one another. I understand that the facilitators may disclose confidential information to other persons or agencies without my permission under the following circumstances which are required by law for the safety and protection of self and others:
∙ Indications of harm to self or others
∙ Awareness of harm being done to a child, elder, or a person with a disability
∙ If compelled to disclose by a court order
You acknowledge that the facilitating therapist of group therapy sessions and Muhsen are not a medical doctor or your personal therapist. Any advice or recommendations given during the duration of group therapy sessions are not intended to be medical advice, diagnosis, or treatment. Participants will not hold Muhsen or support group facilitators liable for any decisions they make. Contact with the therapist and facilitator will remain within the group therapy session. Information given by the facilitating therapist and Muhsen representatives during group therapy session is meant to educate and empower participants. You should always consult with a competent medical professional when making health decisions.
In signing this consent form, I indicate that I have carefully read and understand the Informed Consent Form and that I agree to its terms and conditions. I acknowledge that the co-facilitators have provided the opportunity for group members to discuss and ask questions about the importance and limits of confidentiality and the expectations of the group.
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