Informed Consent to e-Therapy

I have considered, understand, and agree to the risks, benefits, and alternatives to the use of chat and/or email and other forms of online communication in e-therapy with my treatment provider, Lindsey Gittins T/A CyberShrink. I understand that every effort will be made to maintain the confidentiality of our communications, including but not limited to provision of secure chat room and secure storage of both paper and electronic files according to professional standards. I understand that I can choose to conduct email correspondence by regular email or by secure email on request, and that CyberShrink can guarantee the confidentiality of secure email only on her end of the communication. I understand that no communication on the Internet can be guaranteed completely free from potential breach of confidentiality in transit by hackers or Internet service providers or by others who had access to the account or the computer. I take full responsibility for the security of treatment records on my own computer and in my own physical location. CyberShrink will not be held liable for any breach of confidentiality regarding electronic or paper records taking place on my end.

CyberShrink has fully disclosed her credentials, which are available on her website. I hereby confirm that I consider our meetings to occur in cyberspace and that CyberShrink does not claim to be licensed or credentialed in my country of residence. If my country of residence has laws regulating with whom I may seek counselling or therapy online, I am responsible for informing myself and complying with such laws. I accept full responsibility for my decision to work with CyberShrink under these conditions. Any legal disputes will take place in South Africa.

I have been informed of circumstances in which online counselling or e-therapy is not the appropriate or most effective treatment. In the event of a medical, psychiatric, or other situation requiring face to face intervention, I understand that it is my responsibility to seek such help. If I am currently considering or threatening suicide or any form of harm to myself or others, I take full responsibility for seeking appropriate help immediately and for any action I may take. I understand that information on international crisis intervention and help resources includes the following:

For suicide crisis intervention in your country see http://www.befrienders.org/support/helplines.asp

Please know that I won’t stop contact with you if you become suicidal, I simply don’t take on clients whose issue is suicidality as this would be irresponsible. Although I recommend that you contact your nearest emergency room, I can still be of support to you.

By making contact with me, you agree to these terms