WalkTalkNow.org
“Wellness in Movement”
support@walktalknow.org
http://www.walktalknow.org
I, _________________________________, have requested walk/talk therapy (i.e. a therapy session that takes place outside of the therapy office while walking with a “Walker” or a provider who I chose to be part of my healing process.
By signing this form, I 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 personal training and that while movement may be a benefit to me physically, the focus is not on exercise.
● I agree to communicate with my “Walker” if I am uncomfortable physically or
emotionally while participating in walk/talk therapy.
● A “Walker” means the person who uses the Platform to offer to share a walk with another person in exchange for costs associated with the session, and to
transport that person to a destination determined by the date and time in which
the “Walker” has organized in advance.
● I take full responsibility for my medical and physical accidents, issues or ailments during or after a walk talk session and will not hold anyone associated with
WalkTalkNow.org legally, medically 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 “Walker” may not be able to offer this as an option.
● I understand that if we 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 “Walker” will follow my lead should we come into contact with a person I know and my “Walker” will make every effort to preserve client confidentiality and privacy while conducting my walk/talk therapy session. And if we should come into contact with a person that my “Walker” knows, my “Walker” will uphold confidentiality as well.
- I have been advised: – To meet my Walker in a public area – Not to provide my personal contact information to any Walker – To conduct the walk in a public setting during daytime hours – To notify a close friend when I am departing for my walk and when they can expect me to return – To leave and terminate the walk immediately if I become uncomfortable at any time
● I have been further advised that: – WalkTalkNow is not a licensed psychotherapy or medical provider, and provides no such services – WalkTalkNow does not conduct any background check or other research on the Walkers that participate in the program, and does not vouch for Walkers in any way – WalkTalkNow does not guarantee, in any way, any particular therapeutic outcome from the use of this platform – WalkTalkNow serves merely as a platform to connect individuals who have an interest in meeting for the purposes described here. By signing this consent form, I acknowledge that I have been advised of the foregoing, and agree that WalkTalkNow, or its officers, directors, or employees, shall not be liable, in any way, for any reason arising out of my use of the WalkTalkNow platform, my contact and interactions with a Walker, or any therapeutic services that may be provided during or as a result of a “walk.”
Signature:________________________________
● I agree that I have had all questions answered by my “Walker”. I understand and agree to the above regarding Walk/Talk Therapy:
Signature:________________________________
WalkTalkNow 