Release and Consent Agreement for Online and Telephone Art Therapy

The following outlines the limitations associated with facilitating art therapy through Zoom in an online meeting format, where only the client and therapist are present. It uses privacy-compliant technology with a high standard of encryption and security. You will need a webcam, smartphone, or tablet computer with a built-in webcam.

There will be no recording of any of the online sessions by either party. All information disclosed within sessions and written records pertaining to those sessions are confidential and may not be disclosed to anyone without written authorization, except where the disclosure is permitted and/or required by law.

It is important to note that there are limitations and potential risks to online and phone counseling that can affect the quality of the session. Some of these are noted below:

  • Internet services may malfunction during our sessions. If this occurs, end and restart the session. If we are unable to reconnect within 10 minutes, I will call you at the phone number you have noted above and we may have to re-schedule.
  • Telephone or online sessions may result in misunderstanding due to not being able to fully see each other. For example, you may be asked to repeat things more often than you would face-to-face, or you may be asked to describe how you are feeling, thinking, and/or behaving, to understand your reactions or statements more fully.
  • All information transmitted via the Internet may not be secure and although every effort is made to reduce confidentiality breaches, they may occur for unknown reasons.
  • As your Art Therapist, it may be necessary for me to determine if online or phone sessions are appropriate.

In order to reduce confidentiality and privacy risks, I, as the client, understand:

  • It is important to be on time and available for booked online and telephone sessions.
  • I need you to ensure that your space is quiet, private, and free of distractions. This is a way to honour session time as if it were in-person.
  • As part of this agreement for privacy, you agree to inform the Art Therapist if there is another person present during the session, for any reason, and understand that this may lead to the session being terminated.
  • We require a secure Internet connection rather than public/free wi-fi in order to obtain the desired level of security.

Emergency Protocols

As your therapist, I need to know your location in case of an emergency.
In case of an emergency, your location is:

I understand that all information will be kept confidential unless:

  • There is a threat of bodily harm to myself (including suicidal thoughts) or others;
  • There is an indication of child, elder, or vulnerable person abuse;
  • Information is requested by subpoena for court purposes.

By indicating below my acceptance of this agreement, I:

  • acknowledge that I have read this Release and Consent Agreement and understand it and I freely elect to participate, and
  • take full responsibility for telling Jean E. Tait if I feel at any point disturbed by my participation, and
  • release Jean E. Tait from any claims of malpractice, nondisclosure, or lack of informed consent, and
  • freely assume responsibility for any and all risks of the work conducted by Jean E. Tait, whether presently contemplated or hereinafter discovered.

I understand that I may withdraw consent at any time by giving verbal or written notice.