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Consent Addendum for Telepsychological Services
Dr. Tompkins uses Zoom for telepsychology services. This is a HIPAA and PHIPA compliant telehealth platform for the purpose of providing online therapy and assessment services. You can review Zoom’s privacy policy here: You will be sent a link prior to each appointment and  you simply click on the link at the time of your scheduled appointment.
You will need to use a webcam or smartphone during the session. If you prefer to have a phone session (no video), please let me know at which number I can reach you. Telepsychology sessions can be paid by credit card (you will get an invoice by email) or e-transfer to, using the password: psychology2022.
Here are some important points for you to be aware of when using telepsychology services:
  • There are potential benefits (e.g., convenience) and risks (e.g., internet security/consistency) of telepsychology.  
  • Confidentiality still applies for telepsychology services, and nobody will record the session without the permission from the others person(s).
  • It is important to be in a quiet, private space that is free of distractions (including cell phone or other devices) during the session.
  • It is important to use a secure internet connection rather than public/free Wi-Fi.
  • It is important to be on time. If you need to cancel or change your tele-appointment, you must notify the psychologist in advance by phone or email.
  • Please provide a phone number where you can be reached, in the event of technical problems.
  • In the event of a crisis situation, as usual, please call the crisis line at 1-844-437-3247, or 9-1-1 for emergencies.
  • If you are not an adult, your parent or legal guardian must provide their permission (and their contact information) for you to participate in telepsychology sessions.
  • It is your responsibility to confirm with your insurance company that the video sessions will be reimbursed. If they are not reimbursed, you remain responsible for full payment.
Please sign below to indicate that you have read and understood the information presented in this document and that you consent to participate in online appointments using telepsychology platforms. If you are unable to sign and scan this form, please send an email indicating: “I consent to the use of Zoom for my/my child’s online therapy/assessment sessions.”
Thank you for submitting!
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