Consultation Request Form
Please note: Completing this form does not ensure consultation with Raymond Barrett or Telehealth Certification Institute LLC.

Once submitted, A member of our staff will call you within two business days to schedule your consultation.
Email address *
Full Name *
Your answer
Phone *
Your answer
Title and/or area of practice *
Your answer
Have you or your organization completed comprehensive TeleMental Health training?
Please list your telehealth practice goals: *
Your answer
What are some specific areas for which you desire consultation?
Your answer
Short bio of Yourself and your Organization and Services provided.
Your answer
Link to your organization/services (optional)
Your answer
Sign Below to Agree to Terms Listed *
By requesting a consultation session you are expressing a desire to receive consultation services from the Telehealth Certification Institute, LLC (your consultant). You understand that these consultations do not constitute clinical supervision or legal advice and that you remain completely responsible, both ethically and legally, for the decisions you make in your own clinical case situations and technology/practice choices. In making legal decisions about the setup of your telepractice, you are recommended to consult with your own attorney. Your consultant will provide you with an opportunity to discuss clinical cases and issues about which s/he may have some expertise, and s/he may help you consider options for responding, but the comments made for your consideration are not supervision mandates. You also understand that although we may sometimes need to discuss personal issues that may be relevant to your clinical work, these consultation services do not constitute psychotherapy.
Your answer
A copy of your responses will be emailed to the address you provided.
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