Confidential Instructional Video Seminars

By completing the form below, you indicate your agreement to the following confidentiality process:
 Adults and parents of children who permitted us to make educational videos have agreed to have these videos used only under restricted circumstances. The videos must be used solely for professional education, such as: teaching and developing forensic, diagnostic or therapeutic skills, understanding certain psychiatric disorders, teacher-training and therapist-training materials for carrying out therapeutic work or psychotherapy. You are hereby indicating you will not discuss or identify the adults or children whose names may be audible and whose faces may be undisguised. The adults and parents have made a gift to you of knowledge, which we ask you to respect by protecting the dignity of the patients or evaluees through not discussing the information outside of training or research purposes.

—Gilbert Kliman, MD, Medical Director

By completing this confidentiality agreement, I agree to the terms set forth above to view a private web page which contain various instructional videos. Download the full agreement here.

Your Full Name*

Your Profession*

Your Email*

Organization’s Name*

License #*

Street Address*





Reason for requesting videos*

Name of Event you are attending

Date of Event

Location of Event

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