Tele-Health Consent Form

At Northern Virginia Christian Counseling, we utilize Zoom video for telehealth appointments. Zoom video is a HIPPA-compliant, encrypted video software that allows users to access quality, live-streaming video from their computer or smart phone. This form outlines the parameters for use of Zoom video in telehealth appointments.

  1. I understand that online therapy includes the practice of health care delivery, diagnosis, consultation, and treatment. I understand that discussing my present concerns may cause discomfort as difficult issues are addressed and worked through.
  2. Confidentiality will be treated like an office session whereby your counselor will contact appropriate authorities if a risk to self or others is assessed as an immediate and present concern.
  3. Although Zoom video is encrypted and HIPPA-compliant, Northern Virginia Christian Counseling cannot guarantee that all internet-based conversations are secure and confidential. I agree that Northern Virginia Christian Counseling will not be held responsible if any outside party gains access to my information by bypassing security measures through encryption.
  4. I understand that tele-health sessions have limitations compared to in-person sessions, among them being the lack of personal face-to-face interaction and the lack of visual and audio cues in the therapy process.
  5. I understand that online therapy is not appropriate if I am experiencing a crisis or having suicidal or homicidal thoughts. If a crisis or emergency situation arises, I will call 911, visit the local Emergency Room, or contact the National Suicide Hotline at 800-784-2433.
  6. I understand that online counseling is technical and that problems with the internet may occur. If something beyond our control interrupts the session, counselors will call clients on the phone to complete the session.
  7. I understand that most major health insurance companies cover tele-health appointments, and that my session will be billed like a regular office visit. Should you have questions on your specific health plan, we encourage you to contact your insurance company to determine eligibility. During the current COVID-19 pandemic, many insurance companies are also loosening their restrictions in order to ensure continuity of care for their customers.

By signing below, I understand the following: