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Telehealth Informed Consent

During these times of COVID-19 pandemic, sessions are conducted remotely by telehealth. This is a specific Telehealth Informed  Consent  Form, adopted with thanks from the Australian Association of Psychologists Inc (AAPi)

By signing this  consent  form, I  acknowledge and agree to the following.

I understand  that  the benefits of  telehealth / video conferencing therapy sessions can include:

  • Continued access to my therapist during  the  COVID-19  pandemic

  • Continued therapeutic support as part of my treatment plan

  • Avoiding the need for me to travel to my therapist and which would increase the risk of exposure to myself and others  

 

I understand  that  there are potential risks and  downsides of telehealth / video conferencing  therapy sessions, that can include:

  •  Telehealth / video conferencing  may not feel the same as face to face sessions

  • There could be technical problems that could affect the video / sound quality or connection, and this may disrupt the session

  • Although  Professor Eisenbruch uses video conferencing software, which has end-to end  encryption and high security standards, there is still a risk of hacking  or others accessing the  digital connection. 

I understand  that  Professor Eisenbruch is taking the necessary precautions to ensure confidentiality  including:

  • Ensuring the privacy of the telehealth session is upheld in the same way as would be with an in-person session, by choosing a private location or using headphones

  • Not allowing any voice or video recording of the session  

For my part, I have an obligation to not breach the confidentiality of other patients. I will take all steps to ensure that, in attending group sessions, my environment is private and that no third parties will enter be able to hear other patients.

I have been informed of and understand the payment / Medicare processes for my telehealth session and  consent  to these. 

I understand  that I can ask questions about the telehealth session at any time.   

Signed

 

Name

Date