I hereby give my consent to engage in telehealth with Beacon Psychology Services LLC (“BPS”) as part of my psychological treatment. I understand that “telehealth” includes the practice of psychological services such as diagnosis, consultation, and treatment using interactive audio and video communications, particularly the use of programs including but not limited to FaceTime and other telehealth platforms. I understand and agree to the following:
I have read and understand the information provided above, and I have discussed any concerns or questions with my BPS provider. My signature below represents my understanding of the risks and benefits related to the use of telehealth as part of my psychological treatment at BPS.
The parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the some as handwritten signatures for the purposes of validity, enforceability, and admissibility.
Your information will be encrypted.