DISCLAIMER

I acknowledge that I will be using telepsychology services to have my individual session at this time. This may include an extended interview or a regular psychotherapy session.

I acknowledge that there are inherent risks in this or any telecommunication technology (potential hardware, software, other equipment components failure).

I acknowledge that some of these risks may include those associated with technological problems, and those service limitations that may arise because the continuity, availability and appropriateness of specific telepsychology services (e.g. testing, assessment and therapy) may be hindered as a result of those services being offered remotely.

This platform is HIPPA compliant, and every effort will be made to maintain confidentiality on Persona's end.

I will do my best to guard my own privacy in the remote setting, during the telepsychology session.

I accept these inherent risks, and fully consent to receiving telepsychology services from Persona through this medium.

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