**Telehealth Informed Consent – SWinter Counseling and Consulting, LLC**

**Effective Date:** \[Insert Effective Date]

This document outlines the terms of telehealth services provided by SWinter Counseling and Consulting, LLC ("we," "us," or "our"). By participating in telehealth services, you acknowledge and consent to the following:

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**1. Nature of Telehealth**
Telehealth involves the use of secure electronic communications to enable mental health consultations and services when you and your provider are not in the same physical location. This may include video conferencing, phone calls, or secure messaging.

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**2. Confidentiality**
We follow all applicable HIPAA guidelines and utilize secure platforms to protect your personal health information. However, as with any technology, there is always a small risk of a breach. You are responsible for ensuring your own privacy on your end (e.g., using a private space).

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**3. Benefits and Risks**
**Benefits** may include easier access to care, convenience, and continuity of services.
**Risks** include the possibility of technical issues, miscommunication, or interruptions due to equipment failure or loss of internet connection.

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**4. Emergency Procedures**
Telehealth is not appropriate for emergency situations. If you are in crisis, call 911 or go to the nearest emergency room. Clients should have a safety plan and know how to access local emergency services.

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**5. Client Rights**
You have the right to:

* Withdraw consent for telehealth at any time without affecting future care
* Ask questions about the telehealth process
* Request in-person sessions if available and appropriate

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**6. Payment and Insurance**
Telehealth services may be covered by insurance or may be self-pay. Clients are responsible for verifying coverage and understanding their payment responsibilities.

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**7. Consent to Participate**
By continuing with telehealth services, you acknowledge that you:

* Understand the information provided above
* Have had the opportunity to ask questions
* Consent to receiving services via telehealth

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**Contact Us**
For questions or concerns about this consent:

**SWinter Counseling and Consulting, LLC**
\[Your Address or City, State]
\[Phone Number]
\[Email Address]