top of page

Nicola Hyde MBACP
Evergreen Counselling, Frimley
Integrative counsellor

Outdoor Therapy Consent Form

I,  _________________________________,  have  requested  walk/talk  therapy  (i.e.  a therapy  session  that  takes  place outside of the therapy office)  as  part  of  my  counselling process.

By signing this form, I further agree to the following:

I agree that I am responsible for setting the walking pace of the walk/talk session.

I understand that this is not exercise or workout training, and that while movement may be a benefit to me physically, the focus is not about exercise.

I  agree  to  communicate  with  my  therapist  if  I  am  uncomfortable  physically  or emotionally while participating in walk/talk therapy.

I take full responsibility for my medical and physical  well-being and will not hold Evergreen Counselling  legally  or  financially  responsible  for  any  medical conditions and/or accidents that may arise out of walk/talk therapy.

I  agree  to  seek  a  doctor’s  approval  before  beginning  walk/talk  therapy  if appropriate.

If  I  have  any medical conditions that  would be detrimental  to  walk  talk  therapy I agree to disclose this and understand my therapist may not be able to offer this as an option.

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 walk/talk therapy session as counselling to preserve confidentiality.

I understand that should we come in contact with a person whilst in walk/talk therapy my therapist will be lead by me as to whether we continue or take a pause in conversation until they have passed.

I agree that I have had all questions answered by my therapist. I understand and agree to the above regarding Walk/Talk Therapy:

Client’s signature: ______________________    Date: ___________

Counsellor’s signature: _________________


bottom of page