I hereby consent to engage in telemedicine (e.g., internet or telephone based therapy) with The Resilience Group, Inc. The main venue for my psychotherapy treatment will be the office at the address listed below. I understand that telemedicine includes the practice of health care delivery, including mental health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, and/or data communications (including telephone, written, text, email, or video conference, etc). I understand that telemedicine also involves the communication of my medical/ mental health information, both orally and visually, to other health care practitioners.