Where can I find the client’s Informed Consent?

By signing this form, I understand and agree with the following:

I give consent to Talkspace providers to perform treatment services determined to be necessary or advisable for the benefit of my mental health.

Informed Consent

I understand that online counseling or psychiatry services include, but are not limited to, consultation and treatment using interactive audio, video, and/or data communications. If my licensed provider determines that online counseling or psychiatry services are not appropriate for my treatment they will inform me of other options for my care.

I understand that my licensed provider may not be able to provide certain services to me. If my licensed provider believes I need additional or other services, they may refer me to another specialist or type of care, such as seeing a medical doctor for further evaluation and treatment.

I can contact my licensed provider either via the Internet at talkspace.com or with the Talkspace free mobile App. I have signed up for Talkspace therapy services, if I want a "real time" video, audio, or chat session or instant message style discussion with my licensed provider, I will need to schedule it. Otherwise, my licensed provider and I will communicate asynchronously, not as an instant message or in real time.

I understand that online counseling or psychiatry services involve the communication of my medical/mental health information to Talkspace licensed providers.

I understand that the laws that protect the confidentiality of my medical information also apply to online counseling or psychiatry services. As such, I understand that the information disclosed by me during the course of my treatment is confidential. However, there are both mandatory and allowed exceptions to confidentiality, including, but not limited to reporting abuse; expressed threats of violence towards an identifiable victim; and where I make my mental or emotional state an issue in a legal proceeding.

I understand that the sharing of information is under the same HIPAA standards as traditional therapy or psychiatry. Although rare, I understand that there are risks to Internet based services including, not limited to, the possibility, despite reasonable efforts on the part of the Talkspace platform and/or licensed Provider, that: the transmission of my medical information could be disrupted or distorted by technical failures; the transmission of my medical information could be interrupted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons.

I understand that the treatment technique each licensed provider uses is based on the assessment the licensed provider makes of each individual patient’s mental health needs and that a licensed provider’s goal is to provide non-judgemental, high quality service to each individual.

I understand that information of my fees and arrangements for payments were provided to me at the time of registration.

I agree that the location of the treatment is the state where my licensed provider is located, even when I am communicating with my provider by digital or text message platforms. I agree that my treatment is under the licensing rules and laws of the state my provider is licensed in.

By participating in on-line therapy services I am aware of potential benefits and risks:

• Some benefits, which express the essential services of Talkspace, may include:
  • improved access to services,
  • being able to choose the provider I want with specialty experience,
  • the convenience of not having to travel to a provider, and
  • using alternative means of communication that I am comfortable with.
• Although risks are rare, I am aware there are possible risks which include:
  • there may be delay in response from my provider due to technical failures or unforeseen events, and
  • that I may not be able to respond to my provider due to my own technology failures or unforeseen events.

I understand that Talkspace is the custodian of my medical records and in the unlikely event of my licensed provider’s termination of practice, incapacitation, or death, Talkspace will retain possession of my file and records.

I understand that if I am ever dissatisfied with my licensed provider’s services, I have the option to discuss the issues with my provider. If the issues remain unresolved, I can access my designated state’s Board of Examiners available here.

If I decide that I would like to switch to another licensed provider on the Talkspace platform, I can ask my provider to assist me or I can switch providers myself from my Talkspace account. If I need assistance, I can reach out to support@talkspace.com.

It is not recommended that I suddenly stop contacting my provider or "drop out" without talking about ending my treatment. My provider can provide additional information about the expected length of treatment and ending the provider-client relationship.

Informed consent continues throughout the course of my treatment by any provider on the Talkspace platform. My provider will continue to talk with me about risks, benefits or educate me on the process of therapy or psychiatry as we go along.

I understand I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment; nor risking the loss or withdrawal of any benefits to which I would otherwise be entitled.

The Following Applies Only For Parents Completing an Informed Consent for a Teen:

I understand that in consenting to treatment for my teen, I agree to the terms above as they may apply to my teen. I understand that the licensed provider’s client is my teen and not me. I agree to not have access to my teen’s transcripts / “room” without their permission. I also understand that the laws and regulations governing medical records may preclude my teen’s licensed provider from speaking with/communicating with me or from seeing my teen’s medical record without my teen’s express permission. Different States allow different access to parents. Your Teen’s licensed provider will make this information available to your teen and the information is readily available to you on Talkspace.com at the FAQ page.