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Name of client hereby consent to engage in Teletherapy with

Name of client hereby consent to engage in Teletherapy with 2026

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The document is a Teletherapy Informed Consent Form for clients engaging in remote psychotherapy with Denise J. Hockley, LMFT. It outlines the nature of Teletherapy, client rights, confidentiality protections, potential risks and limitations compared to in-person therapy, and the client's right to withdraw consent at any time. The form emphasizes the importance of understanding these terms before participating in Teletherapy.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the designated field where it states '[name of client]'. This is essential for personalizing your consent.
Review the information regarding Teletherapy carefully. Ensure you understand what Teletherapy entails, including the communication methods and potential risks involved.
Read through your rights concerning Teletherapy. Make sure you are aware that you can withdraw consent at any time without affecting future care.
Sign the form in the provided signature area. If someone else is signing on your behalf, indicate their relationship to you.
Finally, enter the date of signing and ensure all fields are completed before submitting the form.

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