Online Counseling Consent

The use of online counseling (also called telecommunication, telemedicine, telehealth, electronic service delivery) has been shown to be effective; it involves special considerations.

1. Prior to offering such services, a client must be seen in face-to-face counseling for a diagnostic assessment to assess suitability for online counseling.
2. If a client changes their legal residence to a location outside of Ohio, Clurchill will not be able to continue to provide services, at which time an appropriate continuity of care plan will be developed. The exception will be those clients who live in Eastern Pennsylvania and have an established case with Churchill.
3. Emergency: In the event of an emergency, the client will call our office (if after hours, our 24-hour service will answer the call), call 911, or go to their nearest emergency department.
4. If the use of technology does not seem to be working well, the client will continue with face-to-face counseling on Churchill’s premises.
5. It is understood that online counseling is to be used as an alternative when it is not possible to obtain services on Churchill’s premises. Examples include mental (e.g., severe agoraphobia) or physical illness, severe weather, power outages, national emergency, etc.
6. Documentation of online counseling sessions will be maintained in the same manner as face-to-face sessions.
7. If the online session is not covered by the client’s insurance, the client will be responsible for payment of the online sessions.
8. Churchill Counseling cannot guarantee that online sessions will remain confidential due to possible risks of hacking, using a public access computer or shared network, using autofiller names and/or passwords. Should Churchill Counseling become aware of a breach of security, the client will be notified as soon as possible.
9. I understand that CCS may offer online counseling via doxy.me (HIPAA protected), Skype, FaceTime, and other apps. Apps that are not HIPAA protected are not guaranteed formats for client confidentiality.
10. Online sessions will not be video or audio recorded.
11. If a session is interrupted due to power or technology failure, attempts will be made to reconnect, either through email or telephone.
12. I choose to use the following methods of electronic service delivery