We will be using Zoom for telehealth services. To access our counseling session on Zoom, please click on the link of the email that I will send you.
Please sign this as a written consent for the use of Telehealth as an acceptable mode of delivering psychotherapy services.
There are risks/limitations in receiving treatment via Telehealth:
1. Technological disruptions
2. Interruptions by unauthorized persons at your location
3. Clinical limitations: I may not see all the non-verbal cues that I would notice if you were in my office
4. Unauthorized access to transmitted and/or stored confidential information
5. My ability to respond in emergencies. I need to know appropriate resources in your locale for contact in case of an emergency
Each time we conduct a telehealth session, I need to know your specific location, to follow telehealth guidelines.
By offering to provide these services, based on our conversation, the use of telehealth is appropriate to your needs. If I find that the use of telehealth is no longer appropriate to your needs, I will inform you, help you find a therapist that will be more appropriate to your needs.
Best,
Sherry Reasbeck, Ph.D., MFT #22431
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use: