Agreement, Consent and Policies for Use of Technology Assisted Counseling Services
About this form
The Agreement, Consent and Policies for Use of Technology Assisted Counseling Services is a legal document that outlines the terms and conditions for engaging in counseling sessions conducted through technology. This form is essential for ensuring that both the client and the counselor agree to the policies associated with Technology Assisted Counseling (TAC). Unlike traditional therapy agreements, this form specifically addresses the unique aspects of conducting sessions via email, phone, and video conferencing, in addition to standard therapy agreements.
Key components of this form
- Description and explanation of Technology Assisted Counseling (TAC).
- Consent for participation in TAC sessions.
- Policies surrounding confidentiality and technology use.
- Client responsibilities for maintaining confidentiality.
- Cancellation and payment policies.
- Emergency procedures and contact information requirements.
When to use this form
This form should be used when a client wants to participate in counseling sessions through technology, such as phone calls or video conferencing. It is necessary whenever a client seeks therapy services that do not take place in a traditional office setting, particularly when consulting with providers who are licensed in the client's state of residence.
Intended users of this form
- Clients seeking therapy through Technology Assisted Counseling.
- Individuals with limited mobility or transportation challenges.
- Clients who prefer the convenience of virtual sessions.
- Anyone who has been assessed and approved for TAC by a licensed therapist.
Instructions for completing this form
- Read the entire form, understanding each section before proceeding.
- Fill in your personal information, including your full name and contact details.
- Provide the names and contacts for your emergency contact and local authorities.
- Sign and date the form to indicate your consent to participate in TAC sessions.
- Ensure your therapist also signs and dates the form to finalize the agreement.
Notarization guidance
In most cases, this form does not require notarization. However, some jurisdictions or signing circumstances might. US Legal Forms offers online notarization powered by Notarize, accessible 24/7 for a quick, remote process.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Common mistakes to avoid
- Failing to read the terms of the form thoroughly, leading to misunderstandings.
- Not providing accurate emergency contact information.
- Ignoring confidentiality requirements during sessions.
- Missing the cancellation notice details, which can lead to fees.
Why use this form online
- Convenient access to counseling services from any location.
- Time savings from not having to travel to appointments.
- Ability to quickly update and edit personal information.
- Secure handling of sensitive information and adherence to privacy regulations.
Legal use & context
- This form provides a clear agreement that establishes client consent and understanding of TAC's limitations.
- By signing this document, both the client and therapist have a mutual understanding of the counseling terms.
- Maintaining confidentiality is critical, and the form sets expectations regarding privacy during sessions.
What to keep in mind
- Technology Assisted Counseling requires a specific agreement to address its unique aspects.
- It is vital for clients to maintain confidentiality and follow the specified policies.
- Understanding both the benefits and limitations of TAC can enhance the counseling experience.
