I consent to engage in telemedicine ( internet or telephone based therapy ) when agreed by me and my counselor to have a telemedicine session. I understand that telemedicine includes the practice of healthcare delivery, including mental health care delivery, diagnosis, consultation, treatment, transfer medical data, and education use an interactive audio, video, and/or data communications. The laws that protect the confidentiality of my medical information also apply to telemedicine. I understand that there are risks and consequences from telemedicine. These may include, but are not limited to, the possibility despite reasonable efforts on the part of my counselor that: that transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by an authorized person; and/or misunderstandings can more easily occur. In addition, I understand that telemedicine-based services and care may not have the same results nor be as complete as face-to-face service. Lastly, I understand that not all insurance plans cover telemedicine. I have read and understood the information provided above.