This Informed Consent for Telemental Health contains important information focusing on conducting counseling services
using the phone or video. Please read this carefully and complete prior to your rst session. When you sign this document
electronically, it will represent an agreement with Counseling Services. Please note: Not all of our counselors are able to
provide Telemental Health services.
Benets and Risks of Telemental Health, also known as Distance Counseling:
Telemental Health refers to providing counseling services remotely using telecommunications technologies, such as
secure video conferencing or telephone. One of the benets of Telemental Health is that the client and clinician can
engage in services without being in the same physical location. This can be helpful in ensuring continuity of mental health
care. Telemental Health, however, requires technical awareness on both parties to be helpful. Although there are benets,
as well as some risks, of Telemental Health, there are some dierences between in-person counseling and distance
counseling. For example:
• Risks to condentiality: Telemental Health sessions take place outside of the counselor’s private oce, so there is
potential for other people to overhear sessions if you are not in a private place during the session. CGTC counselors
will take reasonable steps to ensure your privacy including conducting your session in a private place. It is important
for you to make sure you nd a private place for your session where you will not be interrupted. It is also important
for you to protect the privacy of our session on your cell phone or other device. You should participate in counseling
only while in a room or area where other people are not present and cannot overhear the conversation.
• Issues related to technology: There are many ways that technology issues might impact Telemental Health. For
example, technology may stop working during a session, other people might be able to get access to our private
conversation, or stored data could be accessed by unauthorized people or companies. In the instances where we keep
notes from our sessions, those notes will be in a locked ling cabinet.
• Crisis management and intervention: For immediate support outside of your scheduled Counseling Services
appointment we encourage you to call a crisis line:
» Call Behavioral Health Link/GCAL 1-800-715-4225
» Suicide Prevention Hotline 1-800-273-8255
» Crisis Call Center 1-775-784-8090 or Text ‘answer’ to 839863
» Veterans Crisis Line 1-800-273-8255 (Press 1) or Text to 838255
» Georgia Crisis Line 1-800-715-4225
» Call 911 or go to your nearest emergency room
Ecacy:
Most research shows that Telemental Health is about as eective as in-person counseling. However, there is a risk of
misunderstanding one another when communication lacks visual or auditory cues. While some students may nd an initial
session awkward, most quickly adapt to the unique experience.
Electronic Communications:
With your counselor, you will decide which kind of Telemental Health service to use, either phone or video platform, which
will require internet access and a computer equipped with a microphone and video camera. If you are a new client, you
will be asked to acknowledge the components of this form and submit an Intake form.
Currently, we use a HIPAA compliant video platform, Doxy-me, in which you are provided a link when you book an
appointment. When the counselor nds you in the virtual waiting room, you will be connected at the time agreed upon.
Please take a few minutes to log into the room prior to your rst session. You are solely responsible for any cost to obtain
any necessary equipment, accessories, or software to take part in Telemental Health. You will not have to subscribe to a
video platform to participate.
Condentiality
Counseling Services has the legal and ethical responsibility to make our best eorts to protect all communications that
are a part of our Telemental Health. However, the nature of electronic communications technologies is such that we
cannot guarantee that our communications will be kept condential or that other people may not gain access to our
communications. Counseling Services use updated encryption methods, rewalls, and back-up systems to help keep
your information private, but there is a risk that our electronic communications may be compromised, unsecured, or
accessed by others particularly with cell phone usage. You should also take reasonable steps to ensure the security of
our communications (for example, only using secure networks for Telemental Health sessions and having passwords to
Page 1
A Unit of the Technical College System of Georgia
CGTC Counseling Services
Informed Consent for TeleMental Health
