WAUKESHA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES
CLINICAL SERVICES INFORMED
CONSENT FOR TELEHEALTH SERVICES
CLI-0140; 04/20, Rev. 05/20, 06/20 Page 1
The purpose of this document is to obtain consent for Telehealth Services with Waukesha
County Department of Health and Human Services (WCDHHS). In order to maintain care under
certain circumstances, including during periods of any closure (mandatory or voluntary) for any
reason, we may offer to conduct individual and/or group psychotherapy, psychotherapy with
medication management, and assessments via telehealth service. Telehealth service is the
delivery of healthcare services when the provider and consumer are not in the same physical
location/site through the use of various technologies. This could include video sessions via
telehealth software on a computer, tablet or other approved electronic devices.
Definition of Telehealth
Variously dubbed telemedicine, tele therapy, distance therapy, e-therapy, internet therapy, or
online therapy, “telehealth” is defined as the use of electronic transmission to provide interactive
real-time mental health services remotely, including consultation, assessment, medication
management, diagnosis, treatment planning, counseling, psychotherapy, coaching, guidance,
psycho-education, education and transfer of medical information with an experienced provider.
Due to the rapidly changing circumstances, the approved platform (i.e.: telephone call, email,
texting) of the delivery of these services are subject to change. In the event the above-
mentioned delivery platforms are approved methods of communications, this consent
will serve as authorization to deliver services in that manner.
Telehealth is governed by all the same ethics and laws that cover in-person, in-office services.
Consequently, all other policies, consents and agreements signed with your provider apply to
telehealth services as well. This document is an addendum to all in-office services agreements,
and does not substitute or replace any such agreements.
Advantages and Disadvantages
The main advantage of telehealth is that it provides flexibility for continuity of care when in-
person sessions cannot be conducted. Telehealth by videoconference allows for both verbal
and non-verbal communication in a way that is similar but not identical to in-person
Telehealth is not a universal substitute, nor the same as in-person psychotherapy services.
Some report that telehealth services do not provide the same level of ease, comfort and
connection, and may not seem as “complete” when discussing personal and private matters.
Body language is not as fully visible. Misunderstandings may occur more easily. These
differences may impact the quality of the professional therapeutic relationship. Just as with in-
person psychotherapy, the effectiveness of telehealth services cannot be guaranteed. Discuss
any concerns as they arise.
Telehealth requires some reasonable comfort with technology. Telehealth is best for
augmenting in-person services when a client is unable to come to the office location due to