Telehealth Consent

INFORMED CONSENT FOR TELEPSYCHOLOGICAL SERVICES

Prior to starting video-conferencing services, you need to know and agree to the following:

• There are potential benefits and risks of video-conferencing, that differ from in-person sessions. People may overhear your side of the conversation. Technical problems may hamper the quality of the connection, requiring rescheduling.
• Confidentiality still applies for telepsychology services, and nobody will record the session without the permission from the others person(s).
• We agree to use the video-conferencing platform selected for our virtual sessions, and the psychologist will explain how to use it. Currently, you will (preferably) use either the Firefox or the Chrome browser. I currently use the Zoom Pro platform that is HIPAA compliant. If you haven't used Zoom on your device before, log in a few minutes early to register and install their app. This is the permanent linkhttps://us02web.zoom.us/j/2746654454?pwd=S3c5YXRBdlFoQ3J0YURTdE1Kb25wZz09 If you lose track of it, you can always find it in the first sentence on my website. My website address is always in my email signature line.
• You will need to have high-speed internet and use a computer with a webcam (modern laptops have these) or a 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 tele-appointment, you must notify the psychologist in advance by phone, text or email.
• We need a back-up plan (e.g., phone number where you can be reached) to restart 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 ER to your location, in the event of a crisis situation.
• If you are not an adult, we need the permission of your parent or legal guardian (and their contact information) for you to participate in telepsychology sessions.
• You should confirm with your insurance company that the video sessions will be reimbursed; if they are not reimbursed, you are responsible for full payment.

Third parties that are known to cover telepsychology visits include:

• UNI Behavioral Health Network
• PEHP
• Medicare
• Federal BCBS
• Most Regence plans, but you should confirm that your plan has this benefit

As your psychologist, I may determine that due to certain circumstances, telepsychology is no longer appropriate.