New counseling/mental health client – adult

It is the policy of FCS to communicate confidential and Protected Health Information (PHI) via secure methods; typically in person, by telephone, or via U.S. mail. By signing this consent, you acknowledge that receiving electronic communication (for example, email or text) may put your protected health information at risk. By signing this agreement you give consent for electronic communication about upcoming appointments, answers to your electronically posed questions that may include clinical content, and/or financial information via text and/or email. You also acknowledge that not all email and/or text platforms are encrypted or secure, and grant permission for FCS staff to communicate with you using these methods.

FCS offers telehealth (video) services for therapy/counseling and for psychiatric appointments. If you elect to use telehealth services, your counselor, medication provider, etc. at FCS will be in their office at FCS using a camera and microphone with their computer. You will have the option of using any computer, tablet, or phone that has a camera and internet access. By doing so, you will be able to participate in regular behavioral healthcare services from another location, such as your home. FCS uses a HIPAA compliant telehealth platform that meets recommended standards to protect the privacy and security of the video appointments. Please make efforts to be in a confidential location when participating in telehealth services.
There may be some risks and benefits to using telehealth services:

• • The benefits of a telehealth appointment can be: Reducing the waiting time to see a clinician; keeping appointments that would otherwise be canceled due to travel difficulties or illness; decreasing the amount of time required to fully participate in behavioral healthcare. You may not achieve all these benefits and they are not guaranteed or assured.
• • The risks of a telehealth appointment can be: telehealth appointments may not be exactly the same, or may not be as complete as a face-to- face service; or there could be some technical problems that affect the video visit.

You will always be given a choice about whether to receive telehealth or in-person services. If you agree to sometimes use telehealth services, you can stop participating in telehealth services at any time. The dissemination of any personally identifiable images or information from the telehealth appointments will not occur without your written consent.