Telehealth/Therapy Agreement Sample Contracts

FAMILY THERAPY CENTER OF VIRGINIA TECH
Telehealth Therapy Agreement • March 22nd, 2020
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FAMILY THERAPY CENTER OF VIRGINIA TECH
Telehealth Therapy Agreement • April 24th, 2020
Contract
Telehealth/Therapy Agreement • August 9th, 2020

After intake and the establishment of a therapeutic relationship, it may be possible for treatment delivery to occur via interactive video-conferencing (i.e., virtual “face-to-face” sessions) in lie u of, or in addition to, “in- person” sessions. Video conferencing (VC) is a real-time interactive audio and visual technology that enables our clinicians to provide mental health services remotely. The VC system we use (www.doxy.me) meets HIPAA standards of encryption and privacy protection but we cannot guarantee privacy. You will not have to purchase a plan or provide your name when you “join” our online meeting.

Contract
Telehealth/Therapy Agreement • December 17th, 2020

After intake and the establishment of a therapeutic relationship, it may be possible for treatment delivery to occur via interactive video-conferencing (i.e., virtual “face-to-face” sessions) in lieu of, or in addition to, “in- person” sessions. Video conferencing (VC) is a real-time interactive audio and visual technology that enables our clinicians to provide mental health services remotely. The VC systems we use (www.doxy.me, www.therapynotes.com, Talk url) meet HIPAA standards of encryption and privacy protection but we cannot guarantee privacy. You will not have to purchase a plan to “join” our online meeting.

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