Telehealth Consent

In order to maintain clarity regarding our use of electronic modes of communication during your treatment, we have prepared the following policy. This is because the use of various types of electronic communication is common in our society, and many individuals believe this is the preferred method of communication with others, whether their relationships are social or professional. Many of these common modes of communication, however, put your privacy at risk and can be inconsistent with the law and with the standards of our profession. Consequently, this policy has been prepared to assure the security and confidentiality of your treatment and to assure that it is consistent with ethics and the law.

If you have any questions about this policy, please feel free to discuss this with your clinician.

Email Communications
We will use email communication and text messaging only with your permission and only for administrative purposes unless we have made another agreement. That means that email exchanges and text messages with our office should be limited to things like setting and changing appointments, billing matters, and other related issues. If we have agreed to the use of email communications for clinical matters, you need to be aware that this is not always a secure method of communicating. Further, emails will not be checked on weekends and when our office is closed.

Text Messaging
Because text messaging is a very unsecure and impersonal mode of communication, we do not text message nor do we respond to text messages from anyone in treatment regarding clinical matters. Text messaging through our electronic records system may be used by your therapist to communicate with you regarding appointments and scheduling. It is also used to remind you of your appointments and for you to confirm or cancel your appointment. It is important to note, however, that you should not use this system as a means to communicate with the office, as the electronic system will not alert us that you have texted. If you and your clinician have agreed to use text messaging, you should remember that text messaging is not always reliable and/or secure.

Social Media
Our clinicians do not communicate with, or contact, any  clients through social media platforms like Instagram, Twitter, Facebook, etc. In addition, if we discover that we have accidentally established an online relationship with you, we will cancel that relationship. This is because these types of casual social contacts can create significant security risks for you.

EMERGENCIES
Electronic communication (messaging, text, email) should never be used to communicate in an emergency situation. These communications may not be received or read in a timely manner. Use of these methods of communications for these purposes may result in a termination of services.

 

I have read the above electronic communications policy and agree to abide by it in my communications with my therapist. I understand that electronic communications are not to be used for emergency situations:

This Informed Consent for Telehealth contains important information focusing on providing healthcare services using the phone or the Internet. Please read this carefully, and let your provider know if you have any questions.  When you sign this document, it will represent an agreement between us. 

Benefits and Risks of Telehealth

Telehealth refers to providing psychological services remotely using telecommunications technologies, such as video conferencing or telephone.  One of the benefits of telehealth is that the patient and clinician can engage in services without being in the same physical location.  This can be helpful particularly during the Coronavirus (COVID-19) pandemic in ensuring continuity of care as the patient and clinician likely are in different locations or are otherwise unable to continue to meet in person.  It is also more convenient and takes less time.  Telehealth, however, requires technical competence on both parts to be helpful.  Although there are benefits of telehealth, there are some differences between in-person treatment and telehealth, as well as some risks.  For example:

• Risks to confidentiality.  As telehealth sessions take place outside of your provider’s office, there is potential for other people to overhear sessions if you are not in a private place during the session.  Your provider will take reasonable steps to ensure your privacy. It is important; however, for you to make sure you find a private place for your session where you will not be interrupted.  It is also important for you to protect the privacy of our session on your cell phone or other device.  You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.
• Issues related to technology.  There are many ways that technology issues might impact telehealth.  For example, technology may stop working during a session, other people might be able to get access to our private conversation, or stored data could be accessed by unauthorized people or companies.  
• Crisis management and intervention.  Usually, your provider will not engage in telehealth with clients who are currently in a crisis situation requiring high levels of support and intervention. Before engaging in telehealth, we will develop an emergency response plan to address potential crisis situations that may arise during the course of our telehealth work.

Confidentiality

Your provider has a legal and ethical responsibility to make their best efforts to protect all communications that are a part of telehealth services.  The nature of electronic communications technologies, however, is such that your provider cannot guarantee that communications will be kept confidential or that other people may not gain access to your communications.  Your provider will try to use updated encryption methods, firewalls, and back-up systems to help keep your information private, but there is a risk that electronic communications may be compromised, unsecured, or accessed by others.  You should also take reasonable steps to ensure the security of our communications (for example, only using secure networks for telehealth sessions and having passwords to protect the device you use for telehealth).  

The extent of confidentiality and the exceptions to confidentiality that are outlined in our Informed Consent still apply in telehealth.  Please let your provider know if you have any questions about exceptions to confidentiality.

 

Emergencies and Technology

Assessing and evaluating threats and other emergencies can be more difficult when conducting telehealth than in traditional in-person treatment.  To address some of these difficulties, you will create an emergency plan before engaging in telehealth services.  Your provider will ask you to identify an emergency contact person who is near your location and who they will contact in the event of a crisis or emergency to assist in addressing the situation.  Your provider will ask that you sign a separate authorization form allowing them to contact your emergency contact person as needed during such a crisis or emergency. 

If the session is interrupted for any reason, such as technological connection failure, and you are having an emergency, do not call your provider back; instead, call 9-1-1, or go to your nearest emergency room.  Call your provider back after you have called or obtained emergency services. 

If the session is interrupted and you are not having an emergency, disconnect from the session and your provider will wait two (2) minutes and then re-connect you via the telehealth platform on which you agreed to conduct treatment.  If your provider does not connect via the telehealth platform within two (2) minutes, then call the phone number for the office (251-316-0060). 

Fees

The same fee rates will apply for telehealth as apply for in-person therapy.  If there is a technological failure and we are unable to resume the connection, you will only be charged the prorated amount of actual session time.

Records

The telehealth sessions shall not be recorded in any way unless agreed to in writing by mutual consent.  Your provider will maintain a record of our session in the same way records of in-person sessions in accordance with practice policies.

Informed Consent

This agreement is intended as a supplement to the general informed consent that agreed to at the outset of our treatment together and does not amend any of the terms of that agreement.

Your signature below indicates agreement with its terms and conditions: