Consent

GET IN TOUCH

Contact Details

If you would like someone from our staff to contact you regarding an inquiry for yourself, a child or a friend – please fill out the following information and we’ll be in touch within 24 hours.

If you are experiencing an immediate medical or mental health emergency, please dial 911.

You Have a Voice

Be Heard Now

    This contract indicates consent for distance-oriented counseling or coaching, which take place over a HIPAA compliant telehealth platform.

    By signing this contract, I agree to the following:

    • To find a quiet and protected space for our virtual sessions.
    • Sessions should not be cancelled or changed with less than 48 hours notice unless illness is the reason given. Otherwise there is a late cancel or ‘no show’ fee charged.
    • That during our session time, no one else will be present in the room (unless indicated to the coach and discussed prior to session).
    • That no phone calls, texts, emails or web surfing will occur.
    • That if there is a loss of connection, the counselor or coach will initiate the call back.
    • Sessions are scheduled for 60 minutes to account for any connection disruption, but the session shall last 40-45 minutes.
    • The session and the chat will not be recorded nor will screen shots be taken unless expressly discussed prior to session and with clinical goals in mind.
    • All rules regarding mandated reporting and reporting harm to self or others remain the same as in office sessions as per LMFT / LPC / LCSW / PsyD / Counselor or Coach ethical standards and legal protocol.
    • In case of a crisis an address and contact information on campus needs to be given to the counselor or coach before sessions begin.

    By signing this contract, I indicate my compliance with the above stated expectations. I reserve the right to revoke my consent, in writing, at any time. This consent will be valid for 1 year following the date of signature

    Address

    152 Simsbury Rd
    Avon CT 06001

    Phone

    860-214-7583

    Email

    info@uareheard.com