Telepractice Consent Form
Virtual Counselling (telepractice services) refers to remote counselling services, such as video conferencing or telephone sessions. Online sessions will be hosted through Psychology Today, offering end-to-end encryption.
Benefits (include but are not limited to):
Client and therapist can engage in services without being in the same physical location.
Clients can create a safe and comfortable therapeutic space on their own terms.
Save time and money without travel.
Increased accessibility – including those with mobility or transportation limitations, concerns that make it difficult to leave the home, remote community residents, busy schedules.
Greater opportunity for continuity of care (services not location dependent).
Risks (include but are not limited to):
There are risks when using any mode of virtual communication with your service providers. You need to be aware of potential risks and how to protect information on your end.
Potential for others to hear your conversation if you are not in a private place. Others in your home may overhear the content of your session without your knowledge.
Technology may stop working during a session.
Security could be breached with a recommended virtual platform despite taking necessary precautions, or stored data could be accessed by unauthorized people or companies.
Information could be requested, viewed, changed or deleted if others are allowed access to your computer, tablet, smartphone, or email account.
Information may be vulnerable if stored on a computer, tablet, or smartphone that has been compromised by viruses or malware.
Virtual communication can be intercepted by third parties over the internet if not encrypted. There are no guarantees that data moving over the internet is secure.
Therapist responsibilities
Take all reasonable and appropriate steps to ensure client privacy.
Protect all communications that are part of virtual counselling, as with in-person sessions.
Inform if virtual counselling is not appropriate for your situation and recommend alternative solutions.
Have the means to ensure the person they are speaking to is their client.
Do what is possible to confirm that any personal information sent is being received by you and only you.
Video sessions will not be recorded without your consent; however, should a recording be required, all video and audio recordings will be managed according to Provincial and Federal privacy laws.
Client responsibilities
Find a private place for sessions where others are not present, where others cannot overhear you, and where you will not be interrupted.
—Recommendation: a quiet, private room with a lockable door, from which it would be difficult for passers-by to overhear. Music or white noise outside the room can further muffle sound from the conversation.
Dress appropriately as you would for an in-person session.
Verify ahead of time the best reception for your chosen location.
Agree you will not record a video session.
Maintain the security of your own computer, tablet, and/or smart phone, email service, and the privacy of your environment. This includes virus protection and regularly scanning for viruses and malware, and protecting your information.
Use your personal devices only, not an employer or other person’s computer/device as they may be able to access your information.
Let your counsellor know immediately when a session is no longer private (i.e., when interrupted).
Notify your therapist via email in the event of an unexpected disconnection.
Other suggested best practices to protect your information:
Below are some suggested best practices meant to help you protect your information. It is important to note that these are general best practices and will not guarantee your information won't be accessed by a third party (unless encrypted).
If the information you are wanting to communicate is of a sensitive nature, you may want to seek a more secure method of communication such as a conversation by telephone.
Delete links that you no longer require.
Use your device settings to control what information your apps have permission to access.
Avoid sending personal information or participating in a video session while using public wifi.
Use permission controls on your device to ensure that none of your apps have unnecessary access to your session.
If you have any questions regarding the risks of participating in telepractice sessions, please discuss them with your counsellor.
Consent
By consenting to Telepractice Counselling services, you are agreeing that:
You understand the benefits and risks of using telepractice counselling, therapist responsibilities, client responsibilities, and best practices for protecting your information.
You understand this consent is valid for the duration of service. You may choose to withdraw consent for telepractice counselling at any time.
If you agree with the above and consent to the provision of Telepractice Counselling services please fill out and sign below.