Consent for Virtual Counseling Teletherapy Services

Dear Parent/Guardian,

Due to the current Covid-19 Pandemic, the Comsewogue School District may at times have to provide virtual counseling services delivered by our School Psychologists or Certified School Social Workers throughout the course of the year. Both our Psychologists and Social Workers are committed to providing your son/daughter with the additional counseling support they may need during this unprecedented health situation.

This means that we will be able to provide counseling services through digital meetings/sessions via the Google Classroom/Meet format. In the event that it becomes necessary, the psychologist or social worker and the student would join a computer based session at a designated therapy time and would work on established individual counseling goals, just as would take place within the school setting. This mode of service delivery, when implemented correctly, is noted to have equal outcomes to face-to-face interventions.

I, (Parent/Guardian Name) *

hereby consent for my son/daughter (Child's Name) *

to engage in counseling services via teletherapy as delivered by my child’s psychologist or social worker. I understand that teletherapy includes treatment using interactive audio, video, or data communications.

I understand with respect to Virtual Counseling that I have the right to withhold or withdraw my consent at any time without affecting future care or treatment.

I understand that I am responsible for:

(1) ensuring access to the necessary computer, telecommunications equipment and internet access for the teletherapy sessions

(2) the information security on my computer, and

(3) arranging a location with sufficient lighting and privacy that is free from distractions for my child’s virtual counseling session.

We ask all students and family members to be respectful of the privacy interests of other students. As a result, where possible, students participating in group services should attempt to do so from a location which can not be observed by others and utilize headsets. To the extent that family members observe the delivery of instruction of other students, we ask that you respect the privacy of the other students and not disclose personal information about any student to any third party.

Please note: At this time, your son/daughter may not be participating virtually, however your signature below will indicate your consent for virtual counseling services, in the event that at a future time, your son/daughter might be in need of this service.

Date * +

Parent/Guardian Name *

Parent/Guardian Signature *

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