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INFORMED CONSENT FOR TELE-MEDICINE SERVICES I, _____________________, (patient's name) hereby consent to telemedicine services with Arthur G Hamblin, Psy.D. as part of my psychotherapy. I am being informed that there are potential benefits and risks of video-conferencing (e.g. limits to patient confidentiality) that differ from in-person sessions. With on-line or telephone therapy there is a question of where the therapy is occurring - at the therapist's office or the location of the client. The law is not yet completely settled on this issue, therefore it is my policy to inform patients that they are receiving services from my on-line office (as if they were physically present in a physical office) and therefore are bound by the laws of the State of Idaho. These laws are primarily related to confidentiality as outlined in this form and my disclosure form.
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