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 psychologist determines risk of self-harm;

b. If the psychologist determines risk of harm to others;

c. If the psychologist is informed about or suspects abuse, neglect, or exploitation of a minor or of an incapacitated adult; or

d. If the psychologist 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. Duration and Schedule.  I understand that an online counseling session is typically 60 minutes long and is scheduled ahead of time (at least 24 hours before). In the event that the session is disrupted due to technological failure, both parties will continue to resolve the connection during the session. If the connection remains unstable, both parties shall agree to reschedule to another time, or choose another mode of communication.

 

5. Service Availability, Payment of Fees, Cancellations and No shows.

We request that payments for all appointments are made within 24 upon booking.

We value your time, our time & the service that we provide. A grace period of 15 minutes will be permitted for unforeseen delays you or the psychologist may encounter. If you are late, the session will not be extended beyond 1 hr. However, if the psychologist is late, the session is extended to compensate for the delay.

a. If you have pre-paid & then need to cancel, we will either refund you in full or transfer the payment to another date if you reschedule, provided we have received adequate notice. We ask that you provide us with as much notice as possible when cancelling or rescheduling. A minimum of 24 hours notice for cancelling or rescheduling of appointments is necessary to avoid cancellation fees.

b. If the session is cancelled by the psychologist due to unforeseen circumstances, pre-payment will be refunded in full or transferred to another date if reschedule is made.

c. For cancellations, or rescheduling with less than 24 hours notice, or where a client does not show up for the appointment, a cancellation fee of 100% of the full appointment cost will be charged.

 

I understand that online counseling is not applicable for all.

I understand that online counseling is an option during times when a face-to-face consultation is not possible.

I understand that when physically possible, I shall attend face-to-face sessions with my psychologist.

I understand that I must comply with the safety plan of my psychologist to ensure my personal and physical safety.

I give my consent to my psychologist to activate my emergency contact should the need arise.

I understand the risks and limitations to online counseling.

I understand my duties and responsibilities with online counseling.

All my questions about this agreement have been addressed.

By affixing my name and the date on this form, I affirm that I have read and understood the terms and conditions specified in this Form and agree to abide by them.