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.