• This Informed Consent for Telepsychology contains important information focusing on conducting psychotherapy and counseling using the phone or the Internet with Dunham Counseling Center. Please read this carefully, and let your counselor know if you have any questions. When you sign this document, it will represent an agreement between us.

    Benefits and Risks of Telepsychology

    Telepsychology refers to providing counseling and psychotherapy services remotely using telecommunications technologies, such as video conferencing or telephone. One of the benefits of telepsychology is that the client and clinician can engage in services without being in the same physical location. Although there are benefits of telepsychology, there are some differences between in-person psychotherapy/counseling and telepsychology, as well as some risks.

     For example:

    Risks to confidentiality. You should participate in therapy only while in a room or area where other people are not present and cannot overhear the conversation.

    Issues related to technology.  Please install the Zoom or other application as recommended by your counselor on your phone or electronic device.  Your counselor will discuss HIPAA compliance as it pertains to the video application that is being used.  Look for a text or email 15 to 30 minutes before your scheduled time to see what your conference number and/or passcode is. Please set a timer to go off 10 minutes before our session is to start to have time to check so that you are ready to get on the call. Sessions are generally 50-55 minutes long.

    Emergency Contacts

    We require you to choose one or two emergency contacts with two ways to contact them quickly.

  • Efficacy. Most research shows that telepsychology can be as effective as in-person psychotherapy. However, there is debate about a therapist’s ability to fully understand non-verbal information when working remotely. Please position your web or device camera to see all the people in the session or take turns by camera.

    Fees: A credit card must be put on file before we begin telepsychology.  Although the State of Illinois has recently required insurance plans to permit telepsychology services in a broader manner, your insurance plan may or may not cover it depending on its particular coverage. YOU are responsible for calling the customer service number on your card to check if your specific plan covers it. If it does not, we will bill the full session charge to your card. Any sessions not cancelled at least 24 hours ahead will be charged the full fee.

    Your typed signature below indicates agreement with the above terms and conditions.

  • Ages 12 or older. If under the age of 18 a Legal Guardian must also acknowledge these services below.
  • Required if Client is under the age of 18
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