Teletherapy, also referred to as Telemental health, involves the use of electronic communications to enable physicians and other healthcare professionals—including mental healthcare professionals—to improve the access to quality and appropriate care. Teletherapy includes the practice of healthcare delivery, evaluation, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications.
Teletherapy services with Rochelle Bridges are available to Texas Residents only. I provide teletherapy services for individuals age 13 and above, couples, and families. During national emergencies, exceptions for the age criteria will be made on a case-by-case basis. At this time teletherapy services are only being offered via videoconferencing and telephone. Sessions will not be conducted through email or text messaging, though the client may choose to communicate with me through these electronic mediums in accordance with the Communication Consent Form provided in the Informed Consent.
I am consenting to teletherapy for myself and/or my minor child with Rochelle Bridges, MA, LMFT, Certified Daring Way Facilitator, Interactive Enneagram Accredited Practitioner. This is an addendum teletherapy consent form that must be signed in conjunction with the Informed Consent Form.
I understand that I am NOT allowed to record any video session with Rochelle Bridges for any reason.
I understand that if I am experiencing an emergency, I will follow the procedures laid out in the Informed Consent Form.
I understand that I am responsible for (a) providing the necessary computer, telecommunications equipment, and internet access for my online counseling/teletherapy sessions, (b) abiding by the best practices described in this addendum.
I understand that by signing this agreement, I am not waiving any existing protections for confidentiality, privacy, or other consumer protections as defined in the Informed Consent Form.
I hereby authorize Zoom and its employees, agents and independent contractors, to use teletherapy in the course of my diagnosis and treatment.
I understand that I am responsible for the $130 session fee per 50-minute therapy hour and for upholding the cancellation policies as defined in the Informed Consent Form.
I understand that teletherapy services and care may not be as complete as face-to-face services. I also understand that if my therapist determines that teletherapy is no longer appropriate, I will be referred for face-to-face sessions with Rochelle Bridges, MA, LMFT or to a therapist near me who can provide such services. I understand that there are potential risks and benefits associated with any form of psychotherapy, and that despite my efforts and the efforts of my therapist, my condition may not improve, and in some cases may even get worse.
I understand that in the event of an adverse reaction to the treatment, or in the event of an inability to communicate because of a technological or equipment failure, I shall seek follow-up care or assistance at the recommendation of my therapist.
I understand that the laws that protect privacy and the confidentiality of medical information as defined in the Informed Consent Form also apply to teletherapy. I understand that the information disclosed by me during the course of my treatment is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality as outlined in the Informed Consent Form.
I understand that I have the right to withhold or withdraw my consent to the use of teletherapy in the course of my care at any time, without affecting my right to future care or treatment.
I understand that I have the right to inspect all information obtained and recorded in the course of a teletherapy interaction and may receive copies of this information for a reasonable fee after first consulting with the therapist.