Telehealth & Virtual Session Consent

A Life In Balance DBT Skills Training Group

Service Delivery: HIPAA-Compliant Telehealth (Zoom or Comparable Platform)

Provider Licensure: California and Florida, USA

This document provides informed consent for participation in therapy services delivered via telehealth and outlines expectations, limitations, and safety considerations related to virtual care.

1. Nature of Telehealth Services

I understand and acknowledge that:

• Services are provided via HIPAA-compliant telehealth platforms, including Zoom.

• Telehealth involves the use of secure audio and video communication rather than in-person sessions.

• Telehealth is an appropriate and effective modality for DBT skills training and group-based services.

I understand that telehealth services are held to the same ethical, professional, and legal standards as in-person services.

2. Technology Requirements & Limitations

I acknowledge that participation requires:

• A reliable internet connection

• A device with a functioning camera and microphone

• A private, quiet space suitable for participation

• Basic familiarity with Zoom or the designated platform

I understand that:

• Technology disruptions may occur and can interfere with sessions.

• The provider is not responsible for technical issues on my end.

• Missed content due to technical difficulties does not obligate the provider to provide refunds or additional sessions.

3. Privacy & Confidentiality Considerations

I understand that:

• Virtual platforms used are HIPAA-compliant; however, no technology is entirely risk-free.

• Privacy depends in part on my environment, device security, and internet connection.

I agree to:

• Participate from a private location

• Use headphones when needed to protect privacy

• Prevent unauthorized individuals from viewing or hearing sessions

I understand that the provider cannot control privacy breaches resulting from my environment or technology.

4. Recording Consent & Restrictions

I understand and acknowledge that:

• Sessions may be recorded by the facilitator for educational, quality assurance, or make-up viewing purposes, when applicable.

• Recordings are stored securely and accessed only by authorized individuals.

• Recordings are intended for skills review and are not a substitute for live participation.

I agree that:

• I will not record, photograph, screenshot, or distribute any portion of sessions.

• Unauthorized recording or sharing of session content is strictly prohibited and may result in removal from the program.

5. Safety & Emergency Considerations

I understand that:

• This program does not provide crisis intervention or emergency services.

• Virtual skills training is not appropriate for managing acute emotional crises.

I agree to:

• Seek immediate help through local emergency services (911) if I am in danger.

• Contact the 988 Suicide & Crisis Lifeline or local crisis resources if I need urgent support.

• Maintain my own support system and individual therapeutic care as needed.

6. Voluntary Participation & Right to Withdraw

I understand that:

• Participation in virtual skills training is voluntary.

• I may withdraw from the program at any time.

• Withdrawal does not eliminate financial or participation obligations outlined in the Program Terms & Policies.

• Discontinuation of virtual participation may affect my ability to continue in the program.

7. Acknowledgment & Consent

By signing below, I confirm that:

• I have read and understand this Virtual Skills Training Consent.

• I understand the benefits, risks, and limitations of virtual participation.

• I consent to participate in DBT skills training delivered via HIPAA-compliant virtual platforms.

• I have completed the recording acknowledgment above.