1. I understand that telemental health services are completely voluntary and that I can choose not to do it or not to answer questions at any time. 2. I understand that none of the telemental health sessions will be recorded or photographed without my written permission. 3. I understand that the laws that protect privacy and the confidentiality of client information also apply to telemental health, and that no information obtained in the use of telemental health that identifies me will be disclosed to other entities without my consent. 4. I understand that telemental health may be performed over a communication that is not encrypted (e.g. Skype, Facetime My counselor and I will work together to choose the telemental health communication system/program that will work best for my needs. I do accept the risk that this could affect confidentiality. 5. My counselor has explained to me how video conferencing technology and telephone procedures will be used. I understand that any telemental Health sessions will not be exactly the same as an in-person session due to the fact that I will not be in the same room as my counselor. 6. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that I or my counselor may discontinue the telemental sessions at any time if it is felt that the videoconferencing, text, email, or telephone connections are not adequate for the situation. 7. I understand that I may experience benefits from the use of telemental health in my care, but that no results can be guaranteed or assured. 8. I understand that if there is an emergency during a telemental health session, as with an in-person session, my counselor will call emergency services and my emergency contacts if needed clinically necessary. 9. I understand that in advance of the telemental health session a plan will be in place about how to re-connect if the connection drops while I am in a session. 10. I understand that my counselor and I will create and have in place a safety plan in case of an emergency (see below 11. I understand I have the right to withhold or withdraw this consent at any time.