Client's Rights, Risks, Responsibilities:
1. I, the client, need to be a resident of Nevada(This is a legal requirement for therapists practicing in this state under a NV license)
2. I, the client, have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment.
3. The laws that protect the confidentiality of my medical information also apply to teletherapy. As such, I understand that the information disclosed by me during the course of my therapy or consultation is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality, which are described in the general Consent Form I received at the start of my treatment with Candice Shigemoto.
4. I understand that there are risks and consequences of participating in teletherapy, including, but not limited to the possibility, despite best efforts to high encryption and secure technology on the part of the therapist, that: the transmission of my information could be disrupted or distroted by technical failtures; the transmission of my information could be interrupted by unauthorized persons; and/or the electronic storage of medical inforamtion could be disrupted or distorted by unauthorized persons.
5. The risk that services could be disrupted or distorted by unforeseen problems (technical)
6. In addition, I understand that teletherapy based services and care may not be therapist psychologist believes I would be better served by another form of therapeutic services (e.g. face-to-face services) I will be referred to a professional who can provide such services.
7. I understand that I may benefit from teletherapy, but that results cannot be guaranteed or assured. I understand that there are potential risks and benefits associated with any form of psychotherapy, and that despite my efforts and the efforts of my therapist, my condition may not improve, and in some cases may even get worse.
8. I accept that teletherapy does not provide emergency services. If I am experiencing an emergency situation, I understand that I can call 911 or proceed to the nearest hospital emergency room for help. If I am having suicidal thoughts or making plans to harm myself, I can call the National Suicide Prevention Lifeline at 1.800.272.TALK (8255) for free 24 hour hotline support. Clients who are actively at risk of harm to self or others are not suitable for teletherapy services. If this is the case or becomes the case in the future, my therapist will recommend more appropriate services.
9. I understand that there is a risk of being overheard by anyone near me if I am not in a private room while participating in teletherapy. I am responsible for (1) providing the necessary computer, telecommunication equipment, and Internet access for my teletherapy sessions, and (2) arranging a location with sufficient lighting and privacy that is free from distractions or intrusions for my teletherapy session. It is the responsibility of the psychological treatment provider to do the same on their end.