Virtual Services Agreement

Virtual Services Agreement
Dear Client,

As you are aware, the Novel Coronavirus (COVID-19) has impacted the daily lives of all Californians. All schools and some businesses are closed with more being affected every day. The latest direction from the Department of Health Care Services (DHCS) allows for the provision of temporary Virtual Services also known as Virtual Services.

To avoid a delay in completing your DUI Program, Jackson-Bibby Awareness Group, Inc. will begin offering Virtual Services on April 6th, 2020.

Virtual Services will enable you to continue your DUI classes with a certified counselor via a the Zoom virtual meeting platform temporarily during the COVID-19 crisis. To participate in Virtual Services, you must:

• Register in advance for the session via an email link that will be sent to you in advance of the scheduled session.

• To receive credit for the session, you must:
- Register with your full name as provided to us at Enrollment. Credit will not be given if any aliases or other screen names are input into Zoom.
- Make sure you have paid for your virtual session in advance. Payment of credit card or debit card is only accepted at this time and payments can be made over the phone in advance.
- Be In the virtual meeting at the provided start time. It is recommended that arrive at least 5 minutes early so that you can make sure the program is downloaded and all speakers and microphones are working.
- Attend the session in a private room, free of distractions.
- Stay for the entire session and participate when called upon.
- Not be under the influence of alcohol or other drugs during the session. This is up to the counselor’s and administrators discretion.
Certain technology is required to participate in this program. You must have either a computer, tablet, or phone with a working microphone, speakers, and a camera (for video meetings). You must also be able to download the free Zoom software onto a computer or download the Zoom application on a tablet or phone.

To take advantage of this unique opportunity and keep your DUI treatment program on track, read the privacy policy on the next page and sign where indicated. Return the signed page via email the email option listed above. If you have any questions, please email or contact your program location’s manager.

I have read and agree to Jackson-Bibby Awareness Group, Inc’s Virtual Services Policy.
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Privacy Policy for Remote Client Services
Jackson-Bibby Awareness Group, Inc. will provide Remote Client Services (Telehealth) utilizing the Zoom Virtual Meeting Platform. To participate in Zoom meetings, you must read and agree to Zoom’s Privacy Policy.

Jackson-Bibby Awareness Group, Inc will continue to maintain confidentiality as stated in our Confidentiality Policy. Client’s will also be held to the Confidentiality Agreement signed upon enrollment.
Remote Client Services Release
I (print your name) Full Name* , agree to participate in temporary Remote Client Services (Telehealth) at Jackson-Bibby Awareness Group, Inc. I understand that specific technology is required to participate, and I certify that I have access to the required technology. Additionally, I have read and understand the Zoom privacy policy. I understand that Remote Client Services are being offered on a temporary basis due to the Coronavirus (COVID-19) pandemic, and that once the threat is eliminated, client services will then be available at the DUI Program location only. To receive credit for the session, I understand that I must adhere to the policies outlined in the Telehealth Client Agreement.

I understand that fees for DUI Program services will apply during this time, and that Jackson-Bibby Awareness Group, Inc. will provide me with alternate payment options and methods during the Remote Client Services time period.

I have read and agree to Jackson-Bibby Awareness Group, Inc and Zoom’s Privacy Policy
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On submitting the form, the form(s) will be emailed directly to Jackson-Bibby.
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Virtual Services Agreement

Privacy Policy for Remote Client Services

Remote Client Services Release