Telehealth Informed Consent Form
Teletherapy is the delivery of psychological treatment and assessments provided through interactive internet technologies where the patient and the therapist are not in the same physical location.
Clients are expected to attend therapy sessions regularly and require a minimum of 24 hours notice for cancellation and rescheduling.
A lack of access to the information that might be achieved in a face-to-face visit, but not in a teletherapy session may result in errors in psychological judgment.
I understand that in some instances Telehealth may not be as effective or provide the same results as in-person therapy. I understand that if my therapist believes I would be better served by in-person therapy, my therapist will discuss this with me and refer me to in-person services as needed. If such services are not possible because of distance or hardship, I will be referred to other therapists who can provide such services.
There might be a risk of deficiencies, delays, or failures during the transfer of services due to electronic circumstances.
I understand that there will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law
Teletherapy does not provide emergency services.
All information provided will be held confidential and will not be disclosed without permission, except where disclosure is required by law. The electronic systems that are used throughout the service incorporate network and software security protocols in order to protect the confidentiality of the patient information and data.