Informed Consent Form for Online Counseling
If or when I avail of online counseling/therapy services, I understand that it will be subject to the conditions provided herein below:
1. Confidentiality. Everything taken up during an online counseling/therapy session shall be strictly confidential. No party may record (i.e., audio and/or video) the same, or any portion thereof. Information I disclose or share during a session shall only be released with my permission, except in the following cases in a manner consistent with applicable laws and regulations:
a. If the counselor determines risk of self-harm;
b. If the counselor determines risk of harm to others;
c. If the counselor is informed about or suspects abuse, neglect, or exploitation of a minor or of an incapacitated adult; or
d. If the counselor believes that someone's mental condition leaves the person gravely disabled.
Any violation of this confidentiality obligation may be subject to appropriate disciplinary action.
2. Data Protection. If or when personal data is involved, it will be processed pursuant to and in accordance with applicable data protection laws and policies such as Republic Act 10173, also known as the Data Privacy Act of 2012 (DPA), its implementing rules, appropriate issuances of the National Privacy Commission.
3. Risks and Limitations. Online counseling sessions are inherently subject to certain risks and limitations, such as:
a. technological disruption or failure during an online counseling session
b. limits to confidentiality and security in the application, software, or technology used for the call
c. privacy policy/ies and/or terms of agreement that govern the application, software, or technology used for the call
d. other similar risks
As a data subject, I have certain rights over my personal data that I may exercise subject to the parameters prescribed by law.
4. Cancellations
We value your time, our time & the service that we provide and last minute cancellations costs us. To continue efficient operations, kindly provide us with as much notice when cancelling your appointment.