• I understand that Karen McCrea Clinical Psychologist will engage in a Telehealth psychotherapy session during COVID-19 restrictions in lieu of face to face therapy consultations. 
• I understand the video conferencing technology that will be used will not provide the same experience as an in-person consultation and that all the rights, responsibilities and parameters of in-person treatment apply equally to the telehealth medium. 
• I understand that a Telehealth consultation has potential benefits including easier access to care and the convenience of meeting from a location of my choosing.
• I understand there are potential risks to this technology, including interruptions and technical difficulties.
• I understand the risk of unauthorized access has been reduced as much as possible by the use of Coviu, an HIPAA compliant platform designed specifically for this purpose.
• I understand that my health care provider or I can discontinue the telehealth consultation if it is felt that the videoconferencing connections are not adequate for the situation.
• I acknowledge that I have had a direct conversation with my provider, during which I had the opportunity to ask questions in regard to this medium. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand.

• That I have read or had this form read and/or had this form explained to me.
• That I fully understand its contents including the risks and benefits of the procedure(s).
• That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction.

Thank you!

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