Privacy

Consent

• “Teletherapy” and “video therapy” include consultation, treatment, emails, telephone conversations, and other medical information using interactive audio, video, or data communications.
• Teletherapy and video therapy is governed by the laws of New Jersey.
• The laws protecting the confidentiality of my medical information apply. Unless explicitly agreed otherwise, our teletherapy exchange is confidential. I will not include others in the session or have others in the room unless agreed upon.
• I understand that the tele/video conferencing technology will not be the same as an in-person session with my clinician because I will not be in the same room as my provider. I also understand that, to have the best results for this session, I should be in a quiet place with limited interruptions when I start the session.
• I understand the potential risks to this technology, which include interruptions, unauthorized access, and technical difficulties. I understand that my clinician or I can discontinue the video therapy session if we feel the videoconferencing connections are not adequate for the situation.
• I accept that tele/ video therapy does not provide emergency services. If I am experiencing an emergency, I understand that I can call 911 or proceed to the nearest hospital emergency room for help. 
• In the event our tele/video therapy is not in my best interests, my clinician will explain that to me and suggest some alternative options better suited to my needs.
• I understand there are risks and consequences from teletherapy, including, but not limited to, the possibility, despite reasonable efforts on the part of my therapist, that: the transmission of my information could be disrupted or distorted by technical failures; the transmission of my information could be interrupted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons. I am responsible for information security on my computer.

Rights

• As a client of NJ VIRTUAL COUNSELING GROUP, you have the right to receive services in a professional and caring manner. Our services will respect your individuality and your right to self-determination and will be appropriate to the issues you present.
• You have the right to make and resolve formal concerns, register complaints with the appropriate counseling boards regarding the quality of services received, and refuse services, provided a court of law has not removed this right.
• You have the right to confidentiality about your records as provided by law and judicial order. You also have the right to reasonable access to your summarized records upon request. Client information will be released only when you provide proper written authorization unless otherwise required by law or judicial order.
• In some cases, confidentiality will be breached as required by law. These cases include suspected child abuse or elder abuse, “Tarasoff” and “Ewing” situations in which a severe threat to a reasonably well-identified victim is communicated to the therapist, when the threat to injure or kill oneself is communicated to the therapist, and as required by law or judicial order.
• You understand that in a case of actual or suspected child abuse or neglect, NJ VIRTUAL COUNSELING GROUP is legally obligated to report this information to the proper authorities.
• You have the right to be informed of the name, title, and function of any mental health professional in training assigned to work with you. If you are in treatment with a professional in training, you will be notified, and the name of the clinical supervisor will be made available to you.
• You understand that it is your responsibility to give 24-hour notice when you cannot keep an appointment that has been made for you. Failure to do so may result in a charge you will be responsible for paying – please see the financial agreement.
• You can request a copy of the Privacy Practices of this office and understand that under most circumstances, you must give your written, signed consent to use and disclose your treatment information.