• Tele-Mental Health Consent

    This form is in addition to our consent to treat form that is signed at intake and allows us to conduct sessions over video conferencing
  • Communication Plans and Policies

    In the event that there is a technical failure, both parties should re-launch the program and attempt to re-connect. If this is not successful the therapist will call you at the phone number provided at intake. 

    You will be able to join the virtual "waiting room" prior to our appointment start time. Please plan on signing on for your session 5-10 minutes prior to be sure that your webcam, microphone and internet connection are all working as expected. 

    Please note that in order for us to provide Tele-Mental Health services the clinician that you see must be liscensed in the state in which you live. All session times are in EST. 

  • Ensuring Safety and Appropriateness of Telemental Health Practice

    Please see our website under the resources tab for crisis hotlines and international mental health agencies. Feel free to let your theapist know if you need more unique or targeted referral options due to your circumstances (ex cultural, regional, religious, etc)

  • Risks

    - There can be difficulty for both parties to pick up on visual, non verbal, or gestural cues 

    - Differences in connection speed can lead to disconnection or interuption

    - We will make every effort to eliminate disruptions and interuptions on our end, however we cannot predict whether you will feel completely secure in the privacy of the session

     - Feeling anxiety if symptoms increase during session 

    - Loss of confidentiality if using a public computer, a computer on a shared network, or if others are present in your setting

     

    Benefits

    -Tele-Mental Health services offer flexibility to meet you where you are with a variety of barriers such as transportation, illness, and/or mental health symptoms

    - Reduction of stigma

  • Tele-Mental Health service consent updates:


    Appointments require a credit card on file. This card will be run after confirmation of your appointment. If you do not already have a card on file with Mindfully, please provide your card information to either the front office by emailing info@mindfully.com or when speaking with your therapist.

    Additionally, our No Show and Late Cancellation policy for Tele-Mental Health is different than our outpatient mental health sessions. No Show and Late Cancellation charges WILL be charged to the card on file.

    To be sure our billing team has your most accurate information, please take a picture of the front and back of your insurance card and email to info@mindfully.com

  • By signing below, you agree that you have read and understand the risks associated with Tele-Mental Health, and that you consent to the conditions outlined above (as an adendum to your original consent to treat.)

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