Telehealth Counseling Consent
Graceful Self-Help Counseling, PLLC
Last updated: 11/13/2025
This page provides a preview of the Telehealth Consent form used by Graceful Self-Help Counseling, PLLC. Clients will complete and sign the official version through the secure, HIPAA-compliant client portal before beginning services.
1. Provider Information
Graceful Self-Help Counseling, PLLC
Christina F. Reed, LMFTA
Licensed Marriage and Family Therapy Associate
Telehealth Services for Adults in Kentucky
Christina Reed practices under clinical supervision in accordance with Kentucky state regulations governing LMFTA licensure.
2. What Is Telehealth?
Telehealth involves the use of electronic communication technologies, such as secure video conferencing, phone communication, electronic documentation, and secure messaging, to provide mental health services when the client and therapist are not in the same physical location.
Telehealth services may include:
- Live video counseling sessions
- Secure client portal messaging
- Electronic intake forms and documentation
- Treatment planning and mental health assessments
3. Client Requirements
To participate in telehealth counseling services, clients agree to:
- Be physically located within the state of Kentucky at the time of each session
- Participate in sessions from a private, quiet, and safe environment
- Use a secure internet or cellular connection whenever possible
- Use personal devices rather than public or shared devices whenever possible
- Avoid participating in sessions while driving or operating machinery
4. Potential Risks of Telehealth
While telehealth counseling is generally considered safe and effective, there are potential risks and limitations associated with electronic communication.
Potential risks may include:
- Technical difficulties or interruptions
- Internet connection problems
- Audio or video delays
- Reduced ability to observe nonverbal communication
- Rare security or confidentiality breaches despite safeguards
Reasonable efforts are made to reduce these risks through the use of secure platforms and privacy safeguards.
5. Confidentiality & Security
Graceful Self-Help Counseling, PLLC utilizes secure, encrypted technology platforms for telehealth counseling services whenever possible, including Microsoft Teams and secure client communication systems.
Reasonable safeguards are used to help protect confidentiality and client privacy in accordance with applicable professional and ethical standards.
Although reasonable efforts are taken to protect confidentiality, clients understand that no electronic communication system can guarantee complete security.
Clients are encouraged to:
- Use headphones or earbuds when appropriate
- Use password-protected devices
- Avoid public Wi-Fi when possible
- Participate in sessions behind closed doors or in private settings
6. Approved Telehealth Platforms
Telehealth sessions may be conducted using secure, encrypted platforms such as Microsoft Teams or other technology platforms approved by Graceful Self-Help Counseling, PLLC.
Clients will receive secure session links and instructions prior to appointments.
Telehealth sessions are not recorded unless specifically discussed in advance and written consent is obtained when required.
7. Emergencies & Crisis Situations
Telehealth counseling is not intended for emergency or crisis situations.
If you are experiencing a mental health emergency, suicidal thoughts, or require immediate assistance:
- Call or text 988
- Call 911
- Go to your nearest emergency room
Clients are required to provide:
- A current physical location at the beginning of each session
- An emergency contact person
- A working phone number
8. Consent to Telehealth Treatment
By signing the official Telehealth Consent form within the secure client portal, clients acknowledge and agree that:
- They understand the nature and purpose of telehealth counseling services
- They understand the benefits and limitations of telehealth
- They understand potential privacy and technology-related risks
- They understand they must be located in Kentucky during sessions
- They understand Christina Reed is practicing as an LMFTA under supervision
- They understand they may withdraw consent for telehealth services at any time
9. Technology Failure Plan
If a telehealth session is interrupted due to technical difficulties, reasonable efforts will be made to reconnect using the original platform.
If reconnection is unsuccessful, the therapist may contact the client by phone to determine whether the session can continue safely or should be rescheduled.
10. Communication Policy
Email and electronic messaging should not be used for emergencies, crisis situations, or urgent clinical concerns.
Response times for non-urgent communication may vary and are generally handled during normal business hours.
Clients should call 911 or 988 immediately if experiencing an emergency or safety concern.
11. Contact Information
Graceful Self-Help Counseling, PLLC
Christina F. Reed, LMFTA
Email:
gracefulselfhelpcounseling@gmail.com
This page is provided for informational purposes only. The official Telehealth Consent form will be completed and signed through the secure client portal before services begin.