TELETHERAPY CONSENT FORM

 

I understand that I have the following rights with respect to Telehealth:

1. I have the right to withhold or withdraw consent at any time without affecting my right to any future treatment.

2. The laws that protect the confidentiality of my medical information also apply to Teletherapy.

3. I understand that the sessions performed will be provided on a HIPPA compliant platform.

4. I agree to my child participating in individual teletherapy sessions.

5. For those using their insurance, the sessions will continue to be billed accordingly.

6. You will need to assume responsibility for maintaining confidentiality during the session.