I hereby consent to engage in teletherapy with Ms. Maria Corazon Fernandez. Teletherapy is a form of psychological service provided through the use of telecommunication technology which can include consultation, treatment, transfer of medical data, emails, telephone conversations and/or education using interactive audio or video communications. I also understand that teletherapy involves the communication of my medical/mental health information, both orally and/or visually.
Teletherapy has the same purpose or intention as psychotherapy or psychological treatment sessions that are conducted in person. However, due to the nature of the technology used, I understand that teletherapy may be experienced somewhat differently than face-to-face treatment sessions.
I understand that I have the following rights with respect to teletherapy:
- I, the client, have the right to confidentiality in my teletherapy sessions in the same way I have the right to confidentiality in my face-to-face sessions.
- I understand that there are risks and consequences of participating in teletherapy, including but not limited to, the possibility that transmission of my information could be disrupted or distorted by technical failures or services could be disrupted by unforeseen technical problems.
- I will provide a backup phone no. to restart the session in the event of technical problems.
- I understand that teletherapy based services may not be as complete as face-to-face services and that results cannot be guaranteed or assured.
- I understand that the teletherapy services provided are for clients in the Philippines only.
- I accept that teletherapy does not provide emergency services. If I am experiencing an emergency situation, I understand I can call 911 or proceed to the nearest hospital.
I understand that I have the following obligations with respect to teletherapy:
- 1 understand that I have to be on time for my appointment and if I will be late or be unable to make my appointment, I must notify Ms. Fenandez in advance by phone or email.
- While participating in teletherapy, it is my responsibility to (1) provide myself with needed telecommunications equipment and internet access, and (2) arranging a location with sufficient lighting and privacy that is free from distraction during my sessions.
Procedure for making appointments:
Client will contact Ms. Fernandez by email or through the website Psychmanila regarding the nature of the problem including the source of referral if any. After the consult, and if counseling sessions are needed, Ms. Fernandez and client can agree on a schedule. Client will also make the appointment online to ensure that that time slot is free.
The online appointment app will also give instructions for payment (by bank transfer).
After payment, a copy will be sent to Ms. Fernandez and the client by email at least 1 day before the scheduled appointment. Ms. Fernandez will then send acknowledgement receipt for said payment after the session.
On the day of the appointment, Ms. Fernandez will contact the patient through Viber or Zoom (whichever is more convenient). Session starts once contact is established.The session will be for 50 minutes.
By proceeding with the consultation, I confirm that I have read and understand and agree to the information provided regarding telepsychology psychotherapy sessions.