Book Telehealth Appointment Form
This form is sent to clients who would like to set up a telehealth appointment. This form must be completed prior to scheduling a telehealth appointment. Our office staff will connect with you to set up your appointment once we have received this completed form!
Email address *
Would you like to book a telehealth appointment? *
Please enter you name. *
Your answer
Do you have a particular therapist that you would like to book an appointment with? *
If yes which therapist?
Your answer
Do you have a computer/smartphone/device with internet access that can download our secure app? *
Do you have a private or confidential location (home, office, etc) to receive tele-health counseling? *
Are you comfortable with using live video through our secure app as a way to receive counseling? *
Do you have reliable internet access? *
We require all of our tele-health clients to download our secure app for live video sessions are you ok with this? *
Telehealth clients will have access to sign required documents through a secure client portal in Therapy Notes, are your comfortable with this? *
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