CONSENT TO TELEHEALTH

James Fitzgerald Therapy, PLLC

James Fitzgerald, MS, NCC, LCMHC

359 Dorset Street, Suite 200-2

South Burlington, VT 05403

ELECTRONIC COMMUNICATION

This online form should be considered electronic communication. The form is for reviewing the information and instructions for telehealth services. A more secure version of this document will be available in the Client Therapy Portal through my EHR software Therapy Notes LLC.


Telemedicine Service

Telemedicine describes the use of audio and video technology to conduct counseling or other medicine at a distance. This will allow us to meet when it is not possible for us to meet in person in my office. While conducting telemedicine counseling, I use a secure connection and an online platform that complies with federal health privacy laws. I will give you a link to access this platform via email and this form. You will be able to access our telemedicine appointment with a smartphone, tablet, or computer. Our connection will be most successful if you are connected with reliable high speed internet. Telemedicine allows us to maintain a connection when it would otherwise be impossible. There are also risks to this kind of counseling, including technical difficulties such as connection interruption or unauthorized access. There is the possibility that our internet connection could be too weak to proceed with our session, resulting in an inability to communicate. In this case, either one of us may choose to end the session. There is always the possibility that our connection confidentiality could be breached, though this is very rare. All laws and regulations that apply to in person counseling also apply to telemedicine. An additional regulation in Vermont is that it is illegal to record or tape our sessions without consent, either by client or counselor. If you plan on using your insurance to pay for counseling, it is your responsibility to be sure that it will cover telemedicine. You are responsible for payment in the event that your insurance does not cover telemedicine, or if your coverage changes over time.

Telemedicine Instructions

I use multiple platforms for telemedicine sessions. Zoom professional is the primary platform, because of its security features, stability, and reliability. I will send you a link to the meeting each week before the session. I also use the videoconference applications “Sessions” from Psychology Today and “Jituzu” videoconference from My Clients Plus. I recommend rehearsing getting into the platforms before the time of our first appointment. Closing other programs on your device and turning off the internet on other devices may increase your connection speed. I recommend finding a quiet space, free from distraction for our appointment. It is best if no one else has access to this space for the duration of our appointment; a room with a door is requested. Headphones can also be helpful. If our connection is disrupted or distorted, we can try again by exiting the platform and entering again. If we try a number of times and are unable to connect appropriately, we can try an audio only call for the remainder of the session.