I, , hereby consent to engage in virtual counseling with Patti Hatton, MA, LPC.
Virtual Counseling is a form of videoconferencing provided via internet technology, which can include consultations, treatment, transfer of medical data, emails, telephone conversations and/or education using interactive audio, video, or data communications. Virtual Counseling has the same purpose or intention as face-to-face sessions that are conducted in person. However, due to the nature of the technology used, I understand that virtual counseling may be experienced somewhat differently than face-to-face counseling sessions. I understand that I have the following rights with respect to virtual counseling rights, risks, and responsibilities:
1. I understand that recording and videoing sessions is not allowed.
2. I understand there is a risk that services could be disrupted or distorted by unforeseen technical problems.
3. I understand there is a risk of being overheard by anyone near me if I am not in a private room while participating in virtual counseling.
4. I am responsible providing the necessary computer, telecommunication equipment, and internet access for my virtual counseling.
5. I understand virtual counseling does not provide emergency services. If I am experiencing an emergency, I understand that I can call 911 or proceed to the nearest hospital emergency room for help.
6. I understand that if Patti Hatton, MA, LPC believes I would be better served by another form of therapeutic services (e.g. face-to-face services) I will be referred to a professional who can provide such services.
7. I agree to use a secure internet connection or phone connection rather than public/free Wi-Fi.
8. I agree to a back-up-plan (e.g., phone number where you can be reached) to restart the session or to reschedule it, in the event of technical problems with video.
9. I understand that I may be asked to reschedule my appointment if I am more than fifteen minutes late to my set appointment time.
I have read, understand, and agree to the information provided above regarding virtual counseling.