Teletherapy Consent template

1. Nature of Teletherapy

• Teletherapy delivers counselling or psychotherapy sessions remotely using secure video or telephone technology, offering an alternative to in-person sessions with the same clinical standards.

2. Suitability and Limitations

• My therapist has discussed whether teletherapy is appropriate for my needs. I understand remote delivery may limit observation of non-verbal cues and is not suitable for all crisis situations.

3. Privacy and Setting

• I agree to attend sessions from a private location where I will not be overheard or interrupted, and understand my therapist will do the same. Sessions are not recorded unless both parties agree in writing.

4. Confidentiality and Data Security

• Sessions are held using encrypted, secure platforms where possible. Personal data is processed under the UK GDPR and Data Protection Act 2018. No electronic communication is completely secure, and I accept this inherent risk.

5. Emergency Procedures

• I have provided a current location and emergency contact so my therapist can act appropriately in a crisis. In an emergency, I will contact 999 or attend my nearest A&E.

Client Information

• Full NameText
• Location During SessionsText
• PhoneText
• EmailText

Therapist Information

• Therapist NameText
• Registration No.Text

Emergency Contact

• Contact NameText
• Relationship / PhoneText

Acknowledgment and Signature

• Client SignatureSignature
• Date signed (client)Date
• Therapist SignatureSignature
• Date signed (therapist)Date

• By signing below, I confirm I understand and accept the terms of teletherapy described above.