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What is the purpose of this form?
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The purpose of this form is to provide information to you about, and to obtain your consent to participate in a telehealth consultation with your Psychologist.
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The benefits of having a video consultation can be:
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The risks of having a video consultation can be:
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A video consultation may not be exactly the same and may not be as complete as a face-face session. If the video or phone session does not achieve everything that is needed, we can discuss what to do next.
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There could be technical problems, such as delays due to technology failures that could negatively impact the session.
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Not offer the same visual and sound quality.
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Increase exposure to privacy and digital security risks. (See next section.)
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Telehealth sessions are not a substitute for crisis interventions. If imminent or urgent care is required please contact Emergency Services on ‘000’.
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Confidentiality and Privacy:
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The privacy of any form of communication via the internet or a mobile device is potentially vulnerable and limited by the security of the technology.
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The Psychologist uses systems that meet recommended standards to protect the privacy and security of the video visits. However, the service cannot guarantee total protection against hacking or tapping into the video visit by outsiders. This risk is small, but it does exist.
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You may decrease the risk by using a secure internet connection, meeting with the Psychologist from a private location, and only communicating using secure channels.
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This practice is subject to the Privacy Act 1988 and must comply with obligations related to the collection, use and disclosure of personal information, including through telehealth. The Psychologist must maintain confidentiality and privacy standards during sessions and in creating, keeping and transmitting records.
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At times, audio and video recordings of sessions may be taken to support the Psychologist ’s work, as might occur in a face to face consultation. You will be consulted prior and asked to provide consent before a recording takes place and can refuse to be recorded for any reason. The Psychologist will inform you of the reason for the recording and how it will be stored.
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What does informed consent mean?
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There are a few important principles related to informed consent:
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You must be given relevant information. Ask the Psychologist if you have questions about telehealth and the services offered.
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You have the right to understand the information. Ask the Psychologist if you do not understand.
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You have the right to choose. If you do not agree to telehealth, you may refuse to participate. You may agree to or refuse specific activities and procedures.
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You have the right to stop using telehealth anytime. You can change your mind about telehealth or a specific activity or procedure, even in the middle of a session.
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You can agree or refuse in writing or verbally. You may give your consent using the form below. You may also give or withdraw consent by telling the Psychologist. Consent and refusal that you give verbally will be documented by the Psychologist.
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You can ask about alternatives to telehealth. If you refuse or change your mind about telehealth services, your Psychologist will discuss any other options with you. The Psychologist may or may not be able to offer alternative services.
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Requirements to provide video conferencing.
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Location Because you may be in varied locations for each of our videoconferences, the Psychologist will require you to provide your location at the commencement of each session.
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Equipment I understand that I am responsible for providing the necessary computer, telecommunications equipment and internet access for my telehealth sessions, as well as ensuring that all security features of my computer/tablet/phone are up to date and appropriately configured as well as any costs incurred with the provision.
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Private Space There is a risk of my Telehealth sessions being overheard by others, and that I am responsible for arranging a private location for my telehealth session with sufficient lighting and privacy that is free from distractions/intrusions.
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Use of therapy session materials The Psychologist asks that client’s not make recordings of sessions or use material from the sessions for purposes other than delivering a therapeutic service directly to them. If client’s wish to record sessions or use session material for other purposes, you must seek the Psychologist’s consent to do so.
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I acknowledge that Telehealth involves the communication of my medical and mental health information (verbally and/or visually), over an internet or a telephone connection.
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I understand that Telehealth has the same purpose or intention as psychological treatment sessions that are conducted in person, however due to the nature of the technology used, I also understand that Telehealth may be experienced somewhat differently than face-to-face treatment sessions.
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I understand that my confidentiality is preserved during Telehealth sessions, and that the disclosure and storage of my confidential personal information remains consistent with that stated in the Psychological Service Information/Consent Form.
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I understand that despite best efforts by my Psychologist to use a secure end-to-end encryption platform for the Telehealth conferencing service, there are potential risks and consequences when participating in Telehealth.
These risks include, but are not limited to;
- The possibility, that Telehealth sessions could be disrupted or distorted by technical failures that could negatively impact the session.
- and/or the transmission of Telehealth sessions could be interrupted or accessed by unauthorised persons.
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I acknowledge that I am aware of the technology service being used to conduct my Telehealth session (i.e. Zoom/Microsoft Teams/Phone), and have read and fully understand their privacy policy, and agree to engage with this Telehealth service in accordance with the stipulations of their terms of service agreement.
