Risks and Benefits
I understand the potential risks of telemental health, which may include the following:
1) the video connection may not work, or it may stop working during a session; the video or audio transmission may not be clear; there may be technical problems that interupt the session
3) I or my therapist 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.
4) Though all efforts are made to protect private healthcare information using HIPAA-compliant technology to transmit and receive video and audio and stores all notes and information, there is still a possibility of a breach, and I accept the very rare risk that this could affect confidentiality.
5) It is my responsibility to increase privacy and confidentiality by ensuring that my physical location during videoconferencing is free of other people, that I protect and not share my passwords to computer, websites, phone.
6) I understand that recording my sessions is prohibited.
I recognize the benefits of telemental health, which may include the following:
1) reduced cost and time commitment for treatment due to the elimination of travel;
2) ability to receive psychotherapy when in person, office visits are not possible
3) access to services that are not available in my geographic area.
*** I understand that tele-health is not appropriate for crisis intervention. IF you are in crisis, and require immediate attention please call the 24 hour crisis line at 211, or present to the nearest emergency room.
I give my consent to engage in psychotherapy via videoconferencing, texting, direct messaging, real time messaging, email, phone under the conditions outlined in this document.
I consent to receive appointment reminders by email.