Purpose

Relationship Decision Consultation will be conducted through secure telehealth technology when clinically appropriate and agreed upon by all participants. 

Telehealth allows clients to participate remotely using secure audio and video technology while maintaining the same professional standards expected during in-person services.

Participation in telehealth is voluntary. However, this service requires that both partners must agree to to meet via telehealth. If one partner does not consent to telehealth participation, consultation with this provider is not available. A referral to another consultant providing in-person services may be offered.

Nature of Telehealth

Telehealth involves the delivery of professional consultation services through electronic communication technologies that allow participants and the consultant to communicate in real time.

Although telehealth offers convenience and increased accessibility, it differs from meeting in person and has unique benefits and limitations.

Potential Benefits & Risks

• Greater convenience

• Reduced travel time

• Increased scheduling flexibility

• Improved access to services

• Ability to participate from a familiar environment

• Technical difficulties

• Internet disruptions

• Reduced ability to observe nonverbal communication

• Privacy limitations related to technology

• Delays caused by equipment failure

While every reasonable effort is made to protect confidentiality, no electronic communication system can guarantee absolute security.

Technology Requirements

Clients are responsible for ensuring access to:

• A reliable internet connection

• A device capable of secure video conferencing - camera must remain on during entire consultation session

• A functioning camera and microphone

• A private location appropriate for consultation

Privacy Expectations

Relationship Decision Consultation addresses highly personal and emotionally significant topics.

Accordingly, each participant agrees to participate from a location that supports privacy and minimizes interruptions.

Clients should:

• Use a private room whenever possible.

• Silence phones and electronic notifications.

• Avoid participating while driving or operating machinery.

• Notify the consultant if another person is present.

• Wear headphones when appropriate to improve privacy.

Presence of Other Individuals

Only individuals who have been approved to participate in the consultation may be present during the session. If another person is present, clients must inform the consultant at the beginning of the appointment.

The consultant reserves the right to postpone or discontinue the session if privacy cannot reasonably be maintained. A make up session is note guaranteed. No refunds are available.

Recording

To protect confidentiality and encourage open communication:

• Clients may not audio record, video record, photograph, livestream, or otherwise capture any portion of the consultation.

• Likewise, the consultant will not record sessions.

Client Location

At the beginning of each telehealth appointment, clients may be asked to provide:

• Their current physical location & A telephone number in case the connection is interrupted

• This information is important for emergency response if an urgent safety concern arises during the consultation.

Emergency Situations

Relationship Decision Consultation is not an emergency service.

If you are experiencing:

• Thoughts of harming yourself

• Thoughts of harming another person

• Domestic violence or immediate safety concerns

• A psychiatric emergency

Call 911, go to the nearest emergency department, or contact the appropriate crisis resources in your area (988 is the crisis line).

If an emergency arises during a telehealth consultation and the consultant believes immediate intervention is necessary to protect safety, appropriate emergency services may be contacted.

Technology Failure

If the video connection is interrupted:

1. The consultant will attempt to reconnect.

2. If reconnection is unsuccessful within approximately five minutes, the consultant will attempt to contact the clients using the telephone number provided.

3. If the consultation cannot safely continue, the appointment may be canceled. Future sessions may also be canceled at the discretion of the consultant. No refunds will be issued.

Professional Boundaries

Telehealth appointments are conducted according to the same professional standards as in-person consultations.

Clients agree to:

• • Attend appointments on time.

• • Participate without impairment from alcohol, THC, or non-prescribed substances.

• • Conduct themselves respectfully toward all participants.

• • Notify the consultant of any significant safety concerns.

Confidentiality

Confidentiality during telehealth consultations is governed by the same legal and ethical standards applicable to in-person professional services.

Information discussed during telehealth appointments will remain confidential except where disclosure is authorized by the clients or required or permitted by law.

Appropriate Environment

Relationship Decision Consultation requires thoughtful discussion and focused attention.

Accordingly, telehealth sessions should not occur while:

• Driving

• Shopping

• Working

• Exercising

• Caring for children without another responsible adult present

• Participating in other activities that significantly distract from the consultation

If the consultation environment becomes unsuitable, the consultant may pause or cancel the session. Future sessions may also be canceled at the discretion of the consultant. No refunds will be issued.

Good Faith Participation

Both partners agree to participate honestly and respectfully throughout the telehealth consultation process.

Successful consultation depends upon each participant's willingness to engage openly, thoughtfully, and respectfully.

To promote openness and trust, all individuals present during a telehealth session must be visible to the consultant and disclosed at the beginning of the session. Participation by undisclosed individuals is not permitted.

Clients agree not to use artificial intelligence applications, transcription software, or automated assistants during sessions unless all participants and the consultant have provided prior written consent.

Email may be used for scheduling, billing, and administrative matters only. Email should not be used for clinical consultation, emergencies, or relationship decision-making outside of scheduled sessions.

Fees and Cancellation

Telehealth consultations are subject to the same fee schedule and cancellation policy described in the Informed Consent.

Acknowledgement & Consent

When completing the Intake Form, each partner will acknowledge the following.

• We have read and understand this Telehealth Informed Consent.

• We understand the benefits and limitations of telehealth.

• We understand the potential risks associated with electronic communication.

YOU MAY NOW MOVE ON TO COMPLETE THE INTAKE FORM.