• Informed Consent for Tele-Mental Health Services

    (AV/Gemini Counseling)
  • By signing this document I

  • confirm that I understand and agree with all the following points:

  • 6. These are some of the Advantages of Tele Mental Health Services:

  • 7. The following are some of the Limitations of Tele Mental Health Therapy Services:

  • 8. Therapist responsibilities:

  • a. The therapist will comply with all current and active laws and regulations covering Tele-Mental Health services.

    b. The therapist is required by law to confirm at the start of every video session my identity and location.

    c. Aurolina Valdés is licensed as a Family Therapist in the states of TX and FL therefore I (client) can be located in any of those 2 states. If I (client) am located in any other state or jurisdiction the therapist will have to review the laws on such location to inform me if it is possible for us to plan a session.

    d. As a licensed therapist Aurolina Valdes is mandated to keep written records of every session describing in clinical terms the overall sense of the session and other meaningful clinical details. This records are kept in a HIPAA compliant system called Simple Pratice. The records will be stored for a minimum of 5 years for adult clients and a minimum of 5 years after the age of 18 for minor clients as per the laws of TX and FL.

    e. The therapist will be available at 817-608-6825 in case our video sessions is dropped.

  • 9. Client Responsibilities::

  • 10.    Suggestions from Aurolina Valdes     

    a.    I suggest that if there are other people in the house you use earphones or a headset so that only "your side" of the conversation can be heard by others.

    b.     I strongly suggest that you only communicate through a device that you know is safe and technologically secure (e.g. has a firewall, anti-virus software installed, is password protected, not accessing the internet through a public wireless network, etc.).

    c.     Do not use “auto-remember” names and passwords.

    d.     Consider using a “do not disturb” sign/note on the door.

    e. Please make sure you have a phone with you and that I have that phone number in case have to call you due to technical problems.

  • 11.     EMERGENCY MANAGEMENT PLAN. The therapist can usually return a call or message within 24 hours.

  • If Aurolina is unavailable in the event of an emergency, I am aware that the plan is:

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