Telehealth Counseling Consent
Graceful Self Help Counseling
Last updated: August 29, 2026
This page provides a preview of the Telehealth Consent form used by Graceful Self Help Counseling. Clients will complete and sign the official version through the secure client portal before beginning telehealth psychotherapy services.
1. Provider Information
Graceful Self Help Counseling
Christina F. Reed, M.Ed., MPA
Marriage and Family Therapy Associate
Telehealth Services
Christina Reed provides psychotherapy under clinical supervision in accordance with applicable Kentucky professional requirements.
2. What Is Telehealth?
Telehealth involves the use of electronic communication technologies to provide mental health services when the client and therapist are not in the same physical location.
Telehealth services may include:
- Live video psychotherapy sessions
- Secure client portal communication
- Electronic intake forms and documentation
- Treatment planning
- Mental health assessments and screening
- Other clinically appropriate electronic communication
3. Client Location & Participation Requirements
Clients must be physically located in a jurisdiction where Christina Reed is legally authorized to provide services at the time of each psychotherapy session.
Clients participating in telehealth services agree to:
- Provide their current physical location at the beginning of each telehealth session when requested
- Participate from a private, reasonably quiet, and safe environment whenever possible
- Use a secure internet or cellular connection whenever possible
- Use personal, password-protected devices when possible
- Avoid participating while driving or operating machinery
- Inform the therapist if another person is present or able to hear the session
4. Benefits & Potential Risks of Telehealth
Telehealth can provide convenient access to psychotherapy without requiring the client and therapist to be in the same physical location. However, telehealth also involves potential risks and limitations.
Potential risks may include:
- Technical difficulties or interruptions
- Internet or connectivity problems
- Audio or video delays
- Reduced ability to observe some nonverbal communication
- Interruptions or privacy concerns in the client's environment
- Potential security or confidentiality risks associated with electronic communication
- Situations in which telehealth may not be clinically appropriate
Reasonable safeguards are used to reduce privacy and security risks associated with telehealth services.
5. Confidentiality & Security
Graceful Self Help Counseling uses technology and administrative safeguards intended to protect client privacy and confidential health information during telehealth services.
Reasonable safeguards are used in accordance with applicable privacy requirements, professional standards, and ethical obligations.
Although reasonable measures are taken to protect confidentiality, clients understand that electronic communication and internet-based services may involve privacy and security risks.
Clients are encouraged to:
- Participate from a private location
- Use headphones or earbuds when appropriate
- Use password-protected devices
- Avoid public or unsecured Wi-Fi when possible
- Close unnecessary applications or programs during sessions
- Take reasonable steps to prevent others from overhearing sessions
6. Telehealth Technology
Telehealth psychotherapy sessions may be conducted using Microsoft Teams or another technology platform approved by Graceful Self Help Counseling for clinical services.
Clients will receive information and instructions needed to access their telehealth appointments.
Psychotherapy sessions will not be recorded by Graceful Self Help Counseling unless recording has been specifically discussed in advance and appropriate consent has been obtained.
Clients should not record telehealth psychotherapy sessions without discussing the recording with the therapist and obtaining permission in advance.
7. Emergencies & Crisis Situations
Graceful Self Help Counseling does not provide emergency or crisis-response services through telehealth appointments, email, the website, or the client portal.
If you are experiencing an immediate emergency, are in immediate danger, or require emergency assistance:
- Call 911
- Go to the nearest emergency department
If you are experiencing a mental health or suicide-related crisis, call or text 988 for the Suicide & Crisis Lifeline.
As part of telehealth services, clients may be asked to provide:
- Their current physical location
- A current working phone number
- An emergency contact
- Other information reasonably necessary for emergency planning
If a significant safety concern arises during a telehealth session, the therapist may take appropriate steps consistent with professional, ethical, and legal responsibilities.
8. Consent to Telehealth Treatment
By signing the official Telehealth Consent form through the secure client portal, clients acknowledge that:
- They understand the nature and purpose of telehealth psychotherapy services
- They have been informed of potential benefits, risks, and limitations of telehealth
- They understand potential privacy and technology-related risks
- They understand that their physical location may affect whether services can legally be provided
- They understand that Christina Reed practices as a Marriage and Family Therapy Associate under clinical supervision
- They have had an opportunity to ask questions about telehealth services
- They understand they may withdraw consent to receive services through telehealth
9. Technology Failure Plan
If a telehealth session is interrupted because of technical difficulties, reasonable efforts will be made to reconnect using the original platform.
If reconnection is unsuccessful, the therapist may contact the client using the phone number on file to determine the appropriate next step, which may include continuing through another appropriate method when clinically suitable or rescheduling the appointment.
Clients should keep their current telephone number and emergency contact information updated in the secure client portal.
10. Communication Policy
Email, website contact forms, and routine electronic messages should not be used for emergencies, crisis situations, or urgent clinical concerns.
Electronic communication may not be reviewed immediately. Response times for non-urgent communication may vary and are generally handled during normal business hours.
If you are experiencing an immediate emergency or are in danger, call 911 or go to the nearest emergency department. For a mental health or suicide-related crisis, call or text 988.
11. Questions About Telehealth
Clients are encouraged to ask questions about telehealth, privacy, technology, alternative service options, or any other concerns before consenting to telehealth psychotherapy.
If telehealth is determined to be inappropriate for a particular situation, available alternatives or referrals may be discussed when appropriate.
12. Contact Information
Graceful Self Help Counseling
Christina F. Reed, M.Ed., MPA
Marriage and Family Therapy Associate
Email:
gracefulselfhelpcounseling@gmail.com
Please do not send confidential, sensitive, or emergency information through standard email.
This webpage is provided for informational purposes and allows prospective and current clients to review general information about telehealth services. It does not replace the official informed-consent documents. Clients receiving telehealth psychotherapy through Graceful Self Help Counseling will review and complete the applicable consent documents through the secure client portal.
Graceful Self Help Counseling does not provide emergency or crisis-response services through this website, email, or the client portal. If you are experiencing an immediate emergency or are in danger, call 911 or go to your nearest emergency department. If you are experiencing a mental health or suicide-related crisis, call or text 988 for the Suicide & Crisis Lifeline.