There are additional procedures that we need to have in place specific to Telehealth services. These are for your safety in case of an emergency and are as follows:
You understand that if you are having suicidal or homicidal thoughts, experiencing psychotic symptoms, or in a crisis that we cannot solve remotely, I may determine that you need a higher level of care and Telehealth services are not appropriate.
In addition, there may be non-crisis times when I determine that my Telehealth services are not sufficient, including the need for more frequent treatment than I can provide, or when in-person services or additional healthcare providers are recommended to support your optimal mental health and well-being. We agree to work together to meet your mental health needs to the best of our abilities.
I require an Emergency Contact Person (ECP) who I may contact on your behalf in a life-threatening emergency only. Please enter this person's name and contact information below.
You verify that your ECP is willing and able to go to your location in the event of an emergency.
Additionally, if either you, your ECP or I determine necessary, the ECP agrees to take you to a hospital. Your signature at the end of this document indicates that you understand. I will only contact this individual in the extreme circumstances stated above.
You agree to inform me of the address where you are at the beginning of every session.
You agree to inform me of the nearest mental health hospital to your primary location that you prefer to go to in the event of a mental health emergency.
You agree to inform me of the nearest police department to your primary location that you prefer to go to in the event of an emergency.