Telehealth Disclosure

  • Country Counseling and Exodus Recovery Services Telehealth Disclosure and Informed Consent

    I understand that I may benefit from my engagement in telehealth. These benefits may include, but are not limited to; finding a greater ability to express thoughts and emotions, reduction of symptoms and/or use of substances, avoidance of difficulties with travel or transportation, there may be a greater opportunity to prepare in advance for therapy sessions. I understand that if there is intentional misrepresentation, therapy can be terminated by Country Counseling/Exodus Recovery Services. I have read and understand the information provide in this document, which has also been explained to me by agency staff. I have discussed any concerns with my therapist and my questions have been answered to my satisfaction.
  • Date Format: MM slash DD slash YYYY