Dear Patient,

You have elected to complete your initial packet via electronic means. Please be aware of the following. Confidentiality of E-mail and Video Counseling, Cell Phone and Fax Communication: 1. Email communications by Heritage Counseling, Inc. are delivered via a HIPAA compliant platform. You agree to work with us online using confidential@heritagerincon.com or another encrypted tele-mental health service determined to be suitable by your therapist. 2. If you choose to email from your personal email account, please limit the contents to housekeeping issues such as cancellation or change in contact information. We will not respond to personal and clinical concerns via email. 3. If you call us, please be aware that unless we are both on land line phones, the conversation may not be confidential. Likewise, text messages may not be confidential and should be limited to appointment related questions. 4. If you send a fax to us, our fax line is in a secure location. 5. Any computer files referencing our communication or counseling session are maintained using secure and encrypted measures. 6. We make every effort to keep all information confidential. Likewise, if we are working online together, we ask that you determine who has access to your computer and electronic information from your location. This would include family members, co-workers, supervisors and friends. We encourage you to only communicate through a computer that you know is safe, i.e. wherein confidentiality can be ensured. Be sure to fully exit all online counseling sessions and emails.

For patients participating in Tele-mental Health and video-counseling:

1. You will receive a video link, sent to your email of record, from your therapist that will allow you to connect with them at the time of your scheduled appointment.

2. If we are unable to connect or are disconnected during a video session due to a technological breakdown, please try to reconnect within 10 minutes. If reconnection is not possible, email confidential@heritagerincon.com or call 912-657-9613 to schedule a new session time.

3. As with in person counseling sessions, you are prohibited from recording any tele-mental health sessions and we will never record you.

4. At any time, if you are uncomfortable with online therapy, please let your therapist know. Should either you or your therapist decide to discontinue online therapy, other options will be reviewed to ensure you continue to receive counseling services.