1. Telehealth Psychological Services
Telehealth Psychological Services allows therapists, clinicians and specialists to provide a diagnosis, consultation and treatment using videoconference technology via telephone or computer.
2. Purpose
This group telehealth space is intended as a safe, supportive, and confidential environment where participants can connect with others who share similar mental health experiences, receive professional facilitation, and practice skills related to emotional regulation, coping, and self‑awareness. Membership is voluntary, and the goal is to reduce isolation, build mutual support, and promote healing and growth through shared understanding and guided discussion.
3. Confidentiality
Audio and video recordings of patients during appointments/online visits will be kept private. Medical and personal information of patients are protected by the state and governmental laws.
I understand that group telehealth is a shared treatment setting and that confidentiality is very important. I agree not to record, screenshot, photograph, or share any part of the session, including information about other group members. I also understand that I must join from a private, quiet location where others cannot see or hear the session, and I will take steps to protect my own privacy and the privacy of other participants. While the provider will use reasonable safeguards to protect confidentiality, I understand that confidentiality in a group telehealth setting cannot be guaranteed, and there is always some risk that another participant may disclose information outside of group.
4. Risks and Benefits
Telehealth Psychological Services aims to provide a complete treatment to patients. It is considered and supported by researches that online counseling is an effective way in treatment of various disorders, personal issues and problems. On the other hand, it may not be beneficial and there is no guarantee that the counseling will be effective for patients.There are some risks to participating in group telehealth, including possible technology problems such as poor internet connection, audio/video disruption, or session interruptions. Because this is a group format, there is also a risk that confidentiality may be compromised if another participant shares information outside the group or if someone is not in a private space during session.
5. Payment
This group telehealth space is intended as a safe, supportive, and confidential environment where participants can connect with others who share similar mental health experiences, receive professional facilitation, and practice skills related to emotional regulation, coping, and self‑awareness. Membership is voluntary, and the goal is to reduce isolation, build mutual support, and promote healing and growth through shared understanding and guided discussion.
6. Rights
Patients can withdraw and withhold this consent at any time and they can end the treatment any time they would like to. Any action of patients will not affect the future treatment of or accessibility to counseling services.
7. Consent
By signing this form, I agree that I know and understand the information above. My questions were answered completely during the discussion with the therapist, clinician or specialist. I hereby give my consent to participate into telehealth counseling services provided by the healthcare organization.
Emergency Protocols I need to know your location in case of an emergency. You agree to inform me of the address where you are at the beginning of each session. I also need a contact person who I may contact on your behalf in a life- threatening emergency only. This person will only be contacted to go to your location or take you to the hospital in the event of an emergency.