Therapy
Telehealth Informed Consent
Effective date: 2026-05-23. Clients review and agree to this consent before their first telehealth therapy session. Agreement is recorded, with version, date, time and IP address, at the moment you book an appointment.
Read carefully before your first session. This consent explains how therapy delivered by video or phone works, what it can and cannot do, and what happens in an emergency. If anything is unclear, ask before you agree.
1. What telehealth is
Telehealth is the delivery of clinical therapy using secure, real-time video or, when necessary, telephone, in place of meeting in the same physical room. Your sessions with Melissa Paul, LCSW are provided by telehealth. The same professional, ethical, and legal standards that apply to in-person therapy apply to telehealth sessions.
2. Benefits
Telehealth can make care easier to access, remove travel, and let sessions happen from a private location you choose. For many people it is as effective as in-person therapy.
3. Limitations and risks
Telehealth is not right for every situation. Because your therapist is not in the room, she cannot respond in person to a medical or safety emergency. Technology can fail: video can freeze, audio can drop, and a connection can be lost mid-session. Rarely, a privacy breach can occur despite reasonable safeguards. Some clinical needs are better served by in-person care or a higher level of care, and your therapist may recommend that if telehealth is not appropriate for you.
4. Your location and licensure
Melissa Paul is a Licensed Clinical Social Worker in Colorado and Texas. By law, you must be physically located in a state where she holds an active license at the time of each session. You agree to confirm your physical location at the start of each session and to tell your therapist if you travel. Sessions cannot be provided while you are located in a state where she is not licensed.
5. Privacy, technology, and security
Sessions are conducted over a HIPAA-appropriate video platform. You are responsible for being in a private, quiet space where you will not be overheard, and for using a device and internet connection you trust. Please do not record sessions; your therapist does not record them. Standard clinical documentation is maintained and protected under the Notice of Privacy Practices.
6. Emergencies and crisis
Telehealth is not an emergency service, and sessions are not monitored outside of scheduled times. If you are in crisis, call or text 988 (Suicide and Crisis Lifeline) or call 911. At the start of care you will provide your current physical address and an emergency contact so your therapist can direct help to you if a safety concern arises during a session.
7. If the connection fails
If the connection drops during a session, your therapist will try to reconnect by video and then by telephone at the number on file. If reconnection is not possible, she will contact you to reschedule.
8. Fees and insurance
Telehealth sessions are billed at the rates described during scheduling and on the pricing page. Coverage for telehealth varies by plan; you are responsible for confirming your own benefits.
9. Your rights
Consent to telehealth is voluntary. You may withdraw it at any time and discuss alternatives, including a referral for in-person care, without affecting your right to future care. You may ask questions about the process, the technology, and the security of your information at any time.
10. Acknowledgment
By agreeing to this consent, you confirm that you have read and understood this document, that you have had the opportunity to ask questions, that you understand the benefits and risks of telehealth, and that you consent to receive therapy services by telehealth from Melissa Paul, LCSW.
Client signature: ________________________________________________
Printed name: __________________________________________________
Date: __________________________________________________________
Clinician signature: ____________________________________________ (Melissa Paul, LCSW, M Power Mend)
Date: __________________________________________________________