Telehealth Consent

Effective Date: 1/29/2026

1. Nature of Telehealth Services

Telehealth involves the use of secure video, audio, and electronic communication systems to provide mental health services remotely.

Everwell Counseling Center provides telehealth services through a secure electronic health record (EHR) and telehealth platform.

2. Technology Platforms and Third-Party Services

Telehealth sessions may be conducted through third-party technology providers, including secure EHR and telehealth platforms.

While reasonable efforts are made to ensure privacy and security, Everwell Counseling Center is not responsible for technical failures, service interruptions, or security breaches caused by third-party systems beyond our control.

You agree to review and accept any applicable terms and privacy policies of third-party service providers used for telehealth.

3. Potential Benefits and Risks

Potential Benefits:

• Increased access to services
• Convenience and flexibility
• Continuity of care
• Reduced travel time

Potential Risks:

• Technical disruptions
• Unauthorized access despite safeguards
• Limitations of remote assessment
• Reduced ability to respond to emergencies

4. Confidentiality and Privacy

Telehealth sessions are protected by the same confidentiality standards as in-person services. However, electronic communications may present additional privacy risks.

You agree to participate in sessions from a private, secure location and to use password-protected devices whenever possible.

5. Emergency Procedures and Location Requirements

Telehealth services are not appropriate for all clinical situations, especially emergencies.

You agree to provide your physical location at the beginning of each telehealth session and to maintain updated emergency contact information.

In the event of an emergency, you are responsible for contacting local emergency services by calling 911 or 988.

6. Client Responsibilities

• Ensure reliable internet and equipment
• Use private and secure environments
• Maintain updated contact information
• Participate fully and respectfully
• Notify the therapist of technical difficulties

7. Fees and Billing

Telehealth services are billed in accordance with Everwell Counseling Center’s Billing and Financial Policy.

Everwell Counseling Center is a self-pay practice and does not bill insurance directly. Superbills may be provided upon request.

8. Alternatives to Telehealth

You may choose to receive in-person services when available or discontinue telehealth services at any time.

Your therapist will assist you in identifying appropriate alternatives when needed.

9. Termination of Telehealth Services

Telehealth services may be discontinued if they are no longer clinically appropriate, technically feasible, or in your best interest.

Referrals may be provided when appropriate.

10. Contact Information

Everwell Counseling Center

8151 E Evans Road Ste 9
Scottsdale, AZ 85260

Phone: (623) 698-6892

Website: https://everwellcounselingcenter.com

11. Acknowledgment and Consent

By participating in telehealth services, you acknowledge that you have read, understood, and agree to this Telehealth Consent.

Completion of a form does not create a therapist-client relationship. Your form may not be reviewed for 48 business hours and should not be utilized for outreach during a time of crisis. If you are experiencing an emergency or behavioral health crisis, including thoughts of harming yourself, please call 911 or 988.