Tele-Coaching Informed Consent

Tele-Coaching Sessions Informed Consent

I (Client) am choosing to facilitate my coaching sessions via Zoom, and/or FaceTime with Evergreen Empowerment LLC. These are third-party services used to conduct individual, couples, and family sessions. Through these third-party services practitioners can deliver services all around the United States. By choosing this option, I understand that:

I am responsible for any fee associated with tele-coaching sessions.
Zoom and Facetime are online communications tool allowing for face-to-face video, voice and text-based chat dialogue. Zoom is encrypted and HIPPA compliant.
Appointments will be made via text, or email. Please be online at least five minutes prior to session, alone, in a quiet room, door closed. Coach will appear online at scheduled appointment time.
Treatment plan may be shared with coaches within Evergreen Empowerment LLC to deliver optimal care.
I have the right to withhold or withdraw from Tele-Coaching services at any time without effecting my rights as a Client.

I also understand the following limitations of Zoom virtual coaching sessions:

Any internet-based communication is not 100% guaranteed to be secure/confidential. I agree that Evergreen Empowerment LLC and coaches, are not held responsible if any outside party gains access to Zoom personal or confidential information by bypassing security measures.
Confidentiality should be treated like an in-office session: no outside distractions, turn off cell phones, close other programs on computer and do not be late.
Technical problems may occur before or during sessions and my appointment cannot be started or ended as intended. If the call is disrupted, the coach will contact client within ten minutes. If reconnections cannot occur, the session will be rescheduled via text or email.
In a crisis or emergency situation that needs immediate attention, whereby I am considering seriously harming myself or someone else, I will call the National Suicide Hotline at 988, dial 911 or go to the nearest emergency room.
If I have a complaint, I have the right to lodge a complaint to evergreenempowr@gmail.com.