Tele-Health Policy.

I authorize Sarah Hartman, LMHC of Mind Movement Therapy to use telehealth services for our therapy sessions. Telehealth is the delivery of behavioral health services using interactive technologies (use of audio, video or other electronic communications) between a practitioner and a client who are not in the same physical location.

Electronic systems used are HIPAA-compliant and will incorporate network and software security protocols to protect the privacy and security of health information and imaging data. This system will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption.

I understand that I will need access to and familiarize myself in order to use the telehealth technology. There is a possibility that our technology may fail during a teletherapy session, and that as a result, there may be an interruption; a need to continue by phone; or a need to reschedule.

I have been made aware of the benefits of telehealth by Sarah Hartman, LMHC, such as, but are not limited to: improved communication capabilities during times when in-office sessions are not available, continuity of care, an out-of-office location of my choosing, and reduction of lost work time. I understand and recognize that there are also inherent risks in using telehealth technology that may include: breaches of confidentiality, theft of personal information, and disruption of service due to technical difficulties.

Sarah will provide receipts to submit to your insurance for reimbursement. While most plans cover this platform, there is always a chance that services may be denied. If that occurs, you will be responsible for any incurred charges/fees and will accept all financial responsibility as such.

The need for telehealth services vs. in-person office sessions will continue to be evaluated and will be modified as needed. You retain the option to withhold or withdraw consent for virtual sessions at any time without affecting the right to future care or treatment.

You will abstain from alcohol and/or drug use before and during therapy all virtual sessions.

You are required to share with Sarah Hartman, LMHC your location during the virtual session should an emergency arise. In addition, you authorize that your emergency contact will be notified should an emergency arise.

In order to maintain confidentiality, I agree that I will not share my telehealth appointment link with anyone unauthorized to attend the appointment. In addition, I will not allow another person in the same space during a virtual session nor will I record the session without consent.