This document serves as an agreement to engage in telehealth services with your psychologist and covers information about how these services are provided, recommendations, risks and benefits and related policies, and your authorization.
DESCRIPTION OF TELEHEALTH SERVICE
Telehealth treatment will be provided to you by Edwards Psychological Associates and your individual therapist using a secure telehealth services site that meets HIPAA and HITECH requirements. Session type, length, fees, cancellation and other policies, and general agreements from the Consent Form will remain in place. Please share any concerns you have with your therapist. Clients may access the telepsychology services by using a link provided by your therapist prior to the appointment.
RECOMMENDATIONS
Participate in sessions in a quiet, confidential space in your own home or office (ensure that others cannot overhear you Password protect any technology (including using secure wifi) you will use for sessions. Make sure you are logged out at the end of a session.
Recording a session in any manner without permission is prohibited.
BENEFITS AND RISKS OF TELEHEALTH SERVICES
The major benefit of receiving telehealth services is the ability to have uninterrupted mental health care with the same provider when there are difficulties attending therapy in-person for any reason. Common risks involved with telehealth include distractions, technology problems, potential privacy breaches, and a lack of immediate in-person assistance during a crisis. Your therapist will help you develop an individualized plan for any risks or difficulties you experience during your telehealth sessions.
If your mental health status changes significantly during this course of teletherapy then your therapist will assess whether or not teletherapy is the most appropriate format for ongoing therapy. In the event that a change is necessary you will be provided with recommendations and referrals to more appropriate therapy services. Additionally, you will be asked by your therapist to identify a local emergency contact person and nearby emergency services (i.e., emergency room, local crisis line, etc in the event of a crisis.
When using telehealth there are always risks of technology difficulties. If you experience service interruptions or failures during a telehealth appointment please do the following: attempt to log in again and re-establish connection, after 3 or more unsuccessful attempts to re-connect or after 3-5 minutes, you or your therapist will contact each other by phone in order to continue the session. Therefore, please keep your phone nearby during your telehealth sessions. If you and your therapist are unable to re-connect in any manner during your appointment time, your therapist will send you an email following up and providing options for next steps.
YOUR SIGNATURE BELOW INDICATES THAT YOU HAVE READ THIS DOCUMENT AND AGREE TO ITS TERMS.