Phone, Text, Email, and Telehealth Communication Agreement 

This agreement explains the use of phone, text messaging, email, and telehealth services within this practice. These communication methods are offered for convenience but have limitations regarding confidentiality and appropriate use. 

Phone Communication 

Phone calls may be used for scheduling appointments, brief questions related to treatment, or follow-up communication. 

• Phone calls are not intended for emergency or crisis situations. 

• Calls will typically be returned within 24–48 business hours during business days. 

• Extended phone consultations may be considered a clinical service and may be billed accordingly. 

If you are experiencing a mental health emergency, please call: 

• 911 

• 988 Suicide and Crisis Lifeline 

• Your local emergency services 

• Or go to the nearest emergency room 

Text Messaging and Email 

Text messaging and email may be used for limited communication purposes such as: 

• Appointment scheduling or changes 

• Appointment reminders 

• Brief logistical questionText and email should not be used for 

• Emergency or crisis communication 

• Detailed therapy discussions 

• Sensitive personal information 

While reasonable efforts are made to protect confidentiality, text messaging and email are not fully secure forms of communication, and there is some risk that information could be intercepted or accessed by unauthorized individuals. 

By signing this agreement, you acknowledge and accept these risks. 

Telehealth Services 

Telehealth services allow therapy sessions to be conducted using secure video technology when appropriate. 

Telehealth sessions will follow the same professional standards as in-person therapy. 

Telehealth Requirements 

Clients agree to: 

• Attend telehealth sessions from a private and confidential location whenever possible. 

• Use secure internet access and appropriate technology. 

• Minimize distractions during the session. 

The therapist will also ensure that sessions are conducted from a private and confidential location. 

Telehealth Technology Risks 

While telehealth platforms are selected for privacy and security, potential risks include: 

• Internet connectivity problems 

• Technical failures 

• Unauthorized access to electronic communications 

• Disruptions that may interrupt the sessionIf technology fails during a session, the therapist may attempt to reconnect or complete the session by phone. 

Client Location for Telehealth 

Because therapy regulations vary by location, clients must be physically located in the state where the therapist is licensed at the time of the session unless otherwise permitted by law. 

At the beginning of telehealth sessions, clients may be asked to confirm: 

• Their current physical location 

• A contact phone number 

• An emergency contact 

This is necessary in case emergency services need to be contacted. 

Crisis and Emergency Situations 

This practice does not provide 24-hour crisis services. 

If you are experiencing a crisis, please contact: 

• 911 

• 988 Suicide and Crisis Lifeline 

• Your local crisis center 

• Go to the nearest emergency room 

Text, email, or telehealth messaging should not be used for crisis communication. 

Confidentiality and HIPAA 

This practice takes reasonable precautions to protect your privacy and follows HIPAA privacy guidelines. However, electronic communication carries inherent risks. 

By signing this agreement, you acknowledge: 

• The potential risks associated with electronic communication 

• Your consent to communicate using these methods when appropriate 

Fees and Billing 

Telehealth services are billed at the same rate as in-person sessions unless otherwise specified. 

Insurance coverage for telehealth services may vary. Clients are responsible for verifying coverage with their insurance provider. 

Client Consent 

By signing below, I acknowledge that: 

• I have read and understand this Phone, Text, Email, and Telehealth Communication Agreement. 

• I understand the potential risks related to electronic communication. 

• I consent to participate in telehealth services and use the communication methods described above.