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DEPARTMENT of COUNSELING and HUMAN DEVELOPMENTSUPPLEMENTAL INFORMED CONSENT FOR TELETHERAPY
through the Community Counseling Services Center
This document will provide you with information regarding
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How to fill out telehealth counseling consent form
How to fill out telehealth counseling consent form
01
To fill out a telehealth counseling consent form, follow these steps:
02
Obtain the form: Get a copy of the telehealth counseling consent form either from the counselor or their practice.
03
Read the form: Carefully read and understand the contents of the form, including the purpose of the counseling, the potential risks and benefits of telehealth counseling, and the confidentiality policies.
04
Fill in personal information: Provide your full name, address, contact number, email address, and any other required personal details as specified in the form.
05
Read and acknowledge terms and conditions: Read the terms and conditions section and check the box to indicate your understanding and agreement.
06
Sign and date the form: Physically sign and date the consent form to provide your authorization for telehealth counseling.
07
Return the form: Submit the completed form to the counselor or their practice through the designated method, such as email or in-person.
08
Retain a copy: Make a copy of the filled out form for your own records and reference.
Who needs telehealth counseling consent form?
01
People who intend to receive telehealth counseling services need a telehealth counseling consent form.
02
This includes individuals seeking therapy, counseling, or mental health support through remote means such as video calls or phone calls.
03
The form ensures that individuals understand the process and risks associated with telehealth counseling, as well as their rights and responsibilities as a client.
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What is telehealth counseling consent form?
Telehealth counseling consent form is a document that allows a patient to give permission for their counseling sessions to be conducted remotely through telehealth technologies.
Who is required to file telehealth counseling consent form?
Both the patient and the counselor are required to fill out the telehealth counseling consent form.
How to fill out telehealth counseling consent form?
To fill out the form, the patient and counselor need to provide their information, agree to the terms and conditions, and sign the document.
What is the purpose of telehealth counseling consent form?
The purpose of the telehealth counseling consent form is to ensure that both the patient and counselor are aware of and agree to the use of telehealth technologies for counseling sessions.
What information must be reported on telehealth counseling consent form?
The form typically includes information about the patient and counselor, details about the counseling sessions, consent to telehealth services, and any relevant terms and conditions.
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