Therapeutic Health Services

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Telehealth Consent Form

This consent form is to inform you of the guidelines to our group telehealth sessions and obtain your written consent to participate in this group session via a telehealth platform.

Please note: This Telehealth Consent Form is for THS Client use only. If you are seeking services and would like to connect to care at THS, please visit our Get Help Form here.

  1. You understand that there are benefits and risks of group services being conducted via telehealth (e.g. limits to patient confidentiality) that differ from in-person group sessions.
  2. You understand that confidentiality still applies for telehealth services. Sessions will not be recorded unless permission is acquired from other participants.
  3. You will be utilizing an audio and visual platform for your group telehealth session, via WebEx. WebEx is a HIPAA compliant telehealth platform.
  4. Guidelines in preparation for the group telehealth session:
    • You will need to utilize a webcam or smartphone during the group session.
    • You will need to be in a space free of distractions, where you are alone and can speak freely.
    • You will wear appropriate clothing commensurate with attending group in person.
    • You will ensure you are utilizing a secure internet connection, rather than public or free Wi-Fi. Wearing headphones or keeping the volume on low can prevent sound from travelling.
  5. It is important to be on time. If you need to cancel or unable to attend the group telehealth session, you must notify the clinician in advance via phone.
  6. All patients have the right to be treated with respect, dignity, and privacy at all times, including while receiving services via a telehealth platform.

By signing below, you consent to the use of a telehealth platform to attend and participate in group telehealth sessions with Therapeutic Health Services and agree to the guidelines above.

telehealth-consent.php