INFORMED CONSENT FOR TELEPSYCHOLOGICAL SERVICES
Prior to starting video-conferencing services, we agree to and acknowledge the following:
There are potential benefits and risks of video-conferencing (e.g. limits to patient confidentiality) that differ from in-person sessions.
Confidentiality still applies for telepsychology services, and nobody will record the session without the permission from the others person(s).
We agree to use the video-conferencing platform and/or telephone selected for our virtual sessions, and the mental health practitioner will explain how to use it. Directions can also be accessed online at http://www.baddc.net/telehealth- guide.html.
Both patient and therapist will need to use a webcam or smartphone during the session to access video and audio. If you only have access to a telephone, that is appropriate too, but will not include video.
It is important to be in a quiet, private space that is free of distractions (including cell phone or other devices) during the session.
It is important to use a secure internet connection rather than public/free Wi-Fi.
It is important to be on time. If you need to cancel or change your tele-appointment, you must notify the mental health provider in advance by phone (662-510-6507) or cancellation of reminder text.
We will need a back-up plan (e.g., phone number where you can be reached) to restart the session or to reschedule it, in the event of technical problems.
We need a safety plan that includes at least one emergency contact and the closest ER to your location, in the event of a crisis situation.
If you are not an adult, we need the permission of your parent or legal guardian (and their contact information) for you to participate in telepsychology sessions.
You should confirm with your insurance company that the audio/video sessions will bereimbursed; if they are not reimbursed, you are responsible for full payment.
Your mental health provider may determine that due to certain circumstances, telepsychology is no longer appropriate and that sessions should resume in-person.