Telehealth Consent

USCanada

Field Trip is pleased to offer treatment through a digital platform (Telehealth) for the following services: initial assessment/screening, integration therapy, group integration therapy, and And Beyond Therapy.

I. What You Will Need to Participate in Telehealth Services 

In order to access Therapy via Telehealth, you will need the following things: (a) internet-connected computer, tablet, or smartphone, (b) webcam or built-in camera on the device, and (c) a comfortable place where you can talk in private without interruptions.

Field Trip uses the following platforms for Therapy via Telehealth: Zoom, Google Meet, Doxy, and Portal (Platforms). The Platforms allow for interconnectivity between iOS and Android devices and you will not have to purchase a plan to use them. The Platforms meet standards of encryption and privacy protection required by United States’ laws relating to the protection of protected health information, but we cannot guarantee privacy. We reserve the right to change the platform that we use at any time based on new information.

II. Potential Benefits of Using Telehealth

Telehealth services have potential benefits including easier access to care, continuity of care, increased social connection, and the convenience of meeting from a location of your choosing. Please note that Field Trip can only provide Telehealth services to patients located in the same state as the Clinic.

III. Potential Risks of Using Telehealth

Telehealth platforms include the risk of inadvertent breach of confidentiality and cyberattack resulting in disclosure of your protected health information. Furthermore, the therapy relationship dynamic and/or group therapy dynamic may be influenced by meeting through a digital platform resulting in reduced communicative behavior and lower group cohesion compared to in-person therapy sessions. Additionally, as Telehealth is reliant on third party applications and networks, there is a risk of technology failure before or during a Therapy session.

IV. Voluntary Participation

While participation in Therapy via Telehealth is on a voluntary basis, should you choose to terminate Therapy via Telehealth, we will discuss alternative treatments and modes of accessing therapy. You are encouraged to keep a copy of this form, and refer to it from time to time during your therapy. This consent will continue in effect until you notify us in writing that you have withdrawn your consent.