Aroha contact information online consultation
Welcome to Please fill-in the following details to help us help you better.
Name *
Email *
Address *
Phone number *
Consultation Type *
Consultation Days & Time

Morning : Monday - Friday 10: 00 am -12: 00 pm
Evening: Monday - Thursday 8:00 pm-9: 00 pm
Consultation Date *
Consultation Time *
Reason for consultation
First visit/ Follow-up *
Informed consent for online therapy services


Online therapy involves the use of electronic communications to enable Aaroha's mental health professionals to connect with individuals using interactive video and audio communications.
Online therapy includes the practice of psychological health care delivery, diagnosis, consultation, treatment, referral to resources, education, and the transfer of medical and clinical data.

I understand that I have the rights with respect to Online Therapy:

1. The laws that protect the confidentiality of my personal information also apply to online therapy. As such, I understand that the information disclosed by me during the course of my sessions is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality, including, but not limited to, reporting child, elder, and dependent adult abuse; expressed threats of violence toward an ascertainable victim; and where I make my mental or emotional state an issue in a legal proceeding. I also understand that the dissemination of any personally identifiable images or information from the online therapy interaction to other entities shall not occur without my written consent.

2. I understand that I have the right to withhold or withdraw my consent to the use of online therapy in the course of my care at any time, without affecting my right to future care or treatment.

3. I understand that there are risks and consequences from online therapy, including, but not limited to, the possibility, despite reasonable efforts on the part of the therapist, that: the transmission of my personal information could be disrupted or distorted by technical failures, the transmission of my personal information could be interrupted by unauthorized persons, and/or the electronic storage of my personal information could be unintentionally lost or accessed by unauthorized persons.

4. I understand that if my therapist believes I would be better served by another form of intervention (e.g., face-to-face services), I will be referred to a mental health professional that can provide such services in my area. Finally, I understand that there are potential risks and benefits associated with any form of psychotherapy and that despite my efforts and the efforts of my counsellor, my condition may not improve, and in some cases may even get worse.

5. I understand the alternatives to counselling through online therapy as they have been explained to me, and in choosing to participate in online therapy, I am agreeing to participate using video conferencing technology. I also understand that at my request or at the direction of my therapist, I may be directed to “face-to-face” psychotherapy.

6. I understand that I may expect the anticipated benefits such as improved access to care and more efficient evaluation and management from the use of online therapy in my care, but that no results can be guaranteed or assured.
I have read the informed consent document and agree to give consent *
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