Consent for Telepsychology

There are potential benefits and risks of video-conferencing (e.g. limits topatient confidentiality) that differ from in-person sessions. Confidentiality still applies for telepsychology services, and nobody will recordthe session without the permission from the others person(s). We agree to use the video-conferencing platform selected for our virtualsessions, and the psychologist will explain how to use it. You need to use a webcam or smartphone during the session. It is important to be in a quiet, private space that is free of distractions(including cell phone or other devices) during the session. It is important to use a secure internet connection rather than public/free WiFi. It is important to be on time. If you need to cancel or change your teleappointment, you must notify the psychologist in advance by phone or email. We need a back-up plan (e.g., phone number where you can be reached) torestart the session or to reschedule it, in the event of technical problems. We need a safety plan that includes at least one emergency contact and the closest emergency room to your location, in the event of a crisis situation. If you are not an adult, we need the permission of your parent or legalguardian (and their contact information) for you to participate intelepsychology sessions. As your psychologist, I may determine that due to certain circumstances,telepsychology is no longer appropriate and that we should resume our sessions in-person.