DCI Telehealth Questionnaire
Dakota Counseling Institute, Mitchell, SD
Email address *
Telehealth appointments consist of you and your practitioner having an appointment using secure audiovisual equipment. Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and ensure its integrity against intentional or unintentional corruption.
1. Do you have WiFi available at your home? *
2. Do you have an electronic device with camera (e.g. computer, smart phone, ipad/tablet, etc.) *
3. Would you consider telehealth appointments with your provider during adverse weather conditions? *
4. Would you enjoy telehealth appointments with your provider to supplement face-to-face appointments? *
5. Would you prefer telehealth appointments with your provider instead of face-to-face appointments? *
6. Do you have a Landline or other form of communication as a back-up in case of asynchrony between audio and video, loss of internet connection, or other technical difficulties. *
7. I will need information regarding the appropriate technology in order to participate in the service provided.
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