Consent to Telehealth
Confidentiality still applies for telepsychology services, and nobody will record the session without the permission from the others person(s).
You need to use a webcam or smartphone during the session.
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 clinician in advance by phone or email.
We agree to use the video-conferencing platform selected for our virtual sessions, and the clinician will explain how to use it as well as the log in and payment procedure
We need a safety plan that includes at least one emergency contact and the closest emergency room 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 telehealth sessions.
You should confirm with your insurance company that the video sessions will be reimbursed; if they are not reimbursed, you are responsible for full payment (many commercial and Medicare plans currently allow for these sessions).
As your Clinician, I may determine that due to certain circumstances, telehealth is no longer appropriate and that we should resume our session’s in-person.
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Consent to Telehealth
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