Telehealth Consent

Please correct the errors described below.


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 and go to at or before your appointment time, and enter the virtual waiting room.
  • 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 WI-Fi.
  • 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 know 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 and that we should resume our sessions in-person.

By typing my name I affirm I am legally signing consent
where you can be reached if there are technical problems

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