Consent Form - Informed Consent, Electronic Payment Consent, Gaming Consent, and Professional Disclosure
It can be scary to start a private practice. It can be even scarier when that practice is all online. This is a template of the informed consent I use for my online practice. It has language for both online and in-person therapy. Additionally, I have put in considerations for international therapy practices, and DUE TO POPULAR DEMAND, included a Gaming Consent form. This Template has my Professional Disclosure Statement, my Informed Consent, my Electronic Payment Consent, and Gaming Consent. Additionally, tips and tricks are given for online therapy, including links to tutorials for popular HIPAA compliant video conferencing software, and assisting clients in troubleshooting.
This Template Includes:
Risks and benefits of therapy (specifically individual, couples, and family)
Risks and benefits of online therapy (specifically individual, couples, and family)
Risks and benefits of using gaming in therapy
Addressing dual relationships (in-person and online), including cases regarding providing treatment to multiple family/household members
Limits to confidentiality (for in-person and online therapy)
Telehealth best practice pieces
Billing and payment for private pay clients (and an explanation of superbills)
A fee structure that addresses glitches
Additional Paperwork Provided:
Welcome letter with links on telehealth laws
Checklist for ensuring progress notes reflect best practices and legal and ethical considerations for online therapy
Disclaimer, Terms of Use, and Copyrights
The following documents for purchase are offered for educational purposes. It is not offered with any intent or implied warranty of fitness for a particular purpose nor is there any warranty, guarantee, or general claim that this will in any way provide any level of legal protection.
This document is not a substitute for legal advice or consultation, nor is it a substitute for clinical or ethical consultation or advice. State laws and licensing board rules vary, as do the needs of individual clients. You must modify this document – or rule out its use – as necessary according to your local laws and rules as well as the needs of your clients and your practice.
Photo Credit: https://unsplash.com/photos/C3rK5toz0qA
It can be scary to start a private practice. It can be even scarier when that practice is all online. This is a template of the informed consent I use for my online practice. It has language for both online and in-person therapy. Additionally, I have put in considerations for international therapy practices, and DUE TO POPULAR DEMAND, included a Gaming Consent form. This Template has my Professional Disclosure Statement, my Informed Consent, my Electronic Payment Consent, and Gaming Consent. Additionally, tips and tricks are given for online therapy, including links to tutorials for popular HIPAA compliant video conferencing software, and assisting clients in troubleshooting.
This Template Includes:
Risks and benefits of therapy (specifically individual, couples, and family)
Risks and benefits of online therapy (specifically individual, couples, and family)
Risks and benefits of using gaming in therapy
Addressing dual relationships (in-person and online), including cases regarding providing treatment to multiple family/household members
Limits to confidentiality (for in-person and online therapy)
Telehealth best practice pieces
Billing and payment for private pay clients (and an explanation of superbills)
A fee structure that addresses glitches
Additional Paperwork Provided:
Welcome letter with links on telehealth laws
Checklist for ensuring progress notes reflect best practices and legal and ethical considerations for online therapy
Disclaimer, Terms of Use, and Copyrights
The following documents for purchase are offered for educational purposes. It is not offered with any intent or implied warranty of fitness for a particular purpose nor is there any warranty, guarantee, or general claim that this will in any way provide any level of legal protection.
This document is not a substitute for legal advice or consultation, nor is it a substitute for clinical or ethical consultation or advice. State laws and licensing board rules vary, as do the needs of individual clients. You must modify this document – or rule out its use – as necessary according to your local laws and rules as well as the needs of your clients and your practice.