I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communication Services more fully described above. I understand and accept the risks outlined above, associated with the use of the Services in communications with the Family First Therapy, Inc. I acknowledge and understand that despite recommendations that encryption software be used as a security mechanism for electronic communications, it is possible that communications with Family First Therapy, Inc. may not be encrypted. Despite this, I agree to communicate with Family First Therapy, Inc. using these Services with a full understanding of the risk.
I understand that I am responsible for (1) providing the necessary computer, telecommunications equipment and internet access for my teletherapy sessions, (2) the information security on my computer, and (3) arranging a location with sufficient lighting and privacy that is free from distractions or intrusions for my teletherapy session.
Teletherapy has been determined as an appropriate service delivery model for this patient. Teletherapy will only be used if determined to be as effective as in-person treatment. If teletherapy is not deemed as effective, you will be notified and referred to in-person treatment. For certain individuals, we ask that an adult facilitator be present in the room for assisting with technical difficulties or keeping a child on task. Teletherapy may be used as the primary means of service delivery or may be used in combination with in-person services.