Free Online Counseling for those affected by the COVID-19 Global Pandemic
To help address the mental health concerns that the COVID-19 pandemic and the subsequent enahnced community quarantine raised in our country, PsychConsult Inc. is offering FREE online counseling sessions to the following individuals:

- Frontliners
- Persons with COVID-19
- Persons Under Investigation (PUIs)
- Persons Under Monitoring (PUMs)
- Family members of frontliners, persons with COVID-19, PUIs, and PUMs

If you wish to avail of this service, please fill out this form. For inquiries or concerns, contact: psychconsult.info@gmail.com, 0917 8080193, or (02) 869 29844.
INFORMED CONSENT
Informed Consent for Telepsychology Services

I, _______________________________________, age ________, agree to undergo telepsychology services (i.e., counseling conducted using a video-conferencing platform on telecommunication devices such as laptops and smartphones) with the understanding of and agreement to the following:


1. Ethics and Confidentiality. I can expect the psychologist to uphold utmost ethical standards and confidentiality of the telepsychology session. What I will disclose during the session will be kept strictly confidential. The video-conferencing platform to be used (i.e., doxy.me telemedicine software) ensures that the data is encrypted and sessions are anonymous.


2. Purpose and Process. I agree to undergo telepsychology services for my personal well-being. However, I also understand that talking about my concerns may give rise to negative emotions, which can be shared to the psychologist as part of the process. In addition, as part of a safety plan in case of emergencies, I agree to provide the name and contact details of one person.


3. Risk and Self-Harm. I understand that telepsyhcology services are not suitable for people who are in serious or foreseeable risk of harming themselves or others. In case I have any of these risks, I should consult with a psychiatrist for a more suitable assessment and intervention. Only when I am confident that I am able to keep myself and others reasonably safe and free from harm may I consider availing this service.


4. Recording (Image, Video and Audio) and Note-taking. I agree that both my attending psychologist and I will not make images, videos or any form of recording of the sessions to ensure privacy of the sessions. However, I understand the psychologist will make notes about my session, which he/she will keep in a secure location.


5. Privacy. My psychologist will ensure that he/she is in a private setting to protect my privacy. I will take responsibility to find a private setting for my sessions and ensure I minimize risks to privacy violation on my part. Such risks may increase when I do any of the following: enter personal information on a public use computer, use a computer that is on a shared network, allow a computer to save or auto-remember usernames and passwords, use my work computer for personal communications, or use a public or free wifi service.


6. Attendance and Cancellation. I agree to come on time for the telepsychology session. If I am late, only the remaining time will be utilized for my session. If for any reason I need to cancel my appointment, I will inform the psychologist as soon as possible via email and text.


7. Technological Limitations. If for some reason, an ongoing telepsychology session is interrupted or cut-off, the psychologist will try to reconnect immediately. Should technical problems persist, the psychologist will send me an email to make arrangements to resume the session at the soonest available time.


8. Free Services. This free online service is provided exclusively for those who have been affected by the COVID19 pandemic. It is aimed at frontliners and their family members, and those who have been diagnosed with the illness or are being monitored/investigated for the illness, and their families.

I am acknowledging my understanding and agreement to the terms outlined in the informed consent above: *
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