CONSENT AND GUIDELINES FOR TELEHEALTH TREATMENT

As a result of the current COVID-19 pandemic and correlated CDC guidelines, Integrated Therapies PLLC is committing to limiting possible exposure to this virus by requiring that therapy sessions now take place via telehealth. As a means to protect the health and safety of all parties, in-person sessions will take place via one of the following governmental approved platforms.

Approved Modes for Using Telehealth:

  • iPhone /Android – FaceTime and What’s App
  • Microsoft Teams / Zoom

Please note that while there are many positives, there are also limitations to utilizing telehealth services. Your therapist will take many precautions to insure your privacy and safety. You are expected to do the same and to maintain appropriate boundaries (i.e. finding a quiet space, not allowing other individuals in the session with you–unless a release of information is on file and unless previously discussed with your therapist, not recording or taking pictures, having a support person to contact should one be needed and overall maintaining your safety). Failure to fulfill these expectations can lead to ending the session and depending on circumstance, possible termination of treatment.

Integrated Therapies PLLC strongly encourages you to contact your insurance provider to assess whether or not your insurance covers telehealth services. Should insurance not cover or should insurance deny claims, the financial responsibility then lies on you, the client or guardian of the client as noted in the consent to treat.

In order to process payments timely and effectively while working remotely, we will be utilizing EFT at the time of service. We also strongly encourage you to have a credit card on file. If you do not already have a credit card on file, please print/complete the attached credit card form and scan/email this form back to your therapist.

We understand how overwhelming this information may feel and are here to support you during this transition in whatever way we can. Thank you so much for your understanding during these unprecedented times. We appreciate your cooperation.

Sincerely,
Integrated Therapies, PLLC

***Please note: This is a one-time use e-mail and further communication through this email is strongly discouraged. Cancellations, changes in treatment, and any further communication with your therapist is to be completed via leaving a voicemail/text on your therapist’s private number. You can also communicate any additional information during scheduled sessions. This email and any voicemails for your therapists are NOT to be used for emergencies.

***If you have an emergency, please either dial 911 or go to the nearest emergency room. Below are some additional resources.

Teen 2 Teen Talk Line: (248) 292-0194

Domestic Violence/Sexual Assault Hotline: (877) 922-1274

National Suicide Prevention Hotline: (800) 273-8255

I have read, understand, and agree with the above Telehealth guidelines and consent to telehealth counseling treatment.