• Telehealth Therapy Informed Consent

  • It is my expectation that you will benefit from online therapy as all or part of your psychotherapy, but there is no guarantee. Therapy is conducted using interactive audio and video. Online based services as care may not be appropriate for your needs. If I assess that face to face is more appropriate, I will offer an appointment or provide referrals.

    FAQs on Telehealth and HIPAA during the COVID-19

    nationwide public health emergency

    Confidentiality: The information disclosed during the course of my therapy is confidential, however, there are legal exceptions both mandatory, and permissible, including child, elder, and dependent adult abuse; threats of harm to self or others, or if court-ordered. The therapist will take all precautions to ensure online therapy is confidential, but the client is informed that transmission could possibly be disturbed or distorted by technical failures, or interrupted or accessed by unauthorized persons.

    Appointments and Charges for Services: Patients are responsible for their copayment, co-insurance, and or deductible payments while using TELEHEATH.

    Limitations: On-line therapy plays a useful role in addressing mental health issues. It also has inherent limitations in not being physically present. For instance, body language is limited by this format and technical difficulties can have poor timing. Due to these limitations, this method is not recommended when in a state of crisis or when at high risk

    Why should we do telehealth or internet mental health therapy? At the current time and throughout the COVID-19 Nationwide public health emergency, as of Friday, 3/27/2020 at Midnight the “Stay at Home Order” will take place. We are doing our part by promoting social distancing to help reduce the spread of this virus.

    Procedures should we encounter technical difficulties or disruptions in service: It is understood that when communicating by internet or other electronic means, disruptions in service or other technical difficulties will likely  occur from time to time. Should a disruption occur at a time of crisis, the patient agrees to immediately phone their therapist:

    Dr. Diane Hovey 651-470-4671 ~ Kelly Ryan 651-802-0426 ~ Iris Heieren 651-792-5743 Connie Toavs 651-600-9606 ~ Cate Gerth 612-500-1069 ~ Charlie Bulman 651-358-4611 ~ Andrea Walker 651-280-8653 ~ Carol Ladd 651-587-8722

    1. I agree that I reside in the state of Minnesota, or border state as permitted by law/insurance 2. I am aware that a “HIPPA Notice of Privacy” is available for me to read on www.aheartt.com 3. I agree to participate in telemental health therapy. I have read, understood and comply with the agreed upon policies. I understand that the fee agreed upon by Alliance for Healing and I, is due at the time of service.

    I have received and understand the Telehealth Policy of aHeARTT / Alliance for Healing

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