ELECTRONIC COMMUNICATION AGREEMENT

Email and text communication can provide for a fast and easy way to communicate for those issues that are non-emergent, non-urgent or non-critical. It is not a replacement for the interpersonal contact that is the basis of the client-therapist relationship, but can be useful for scheduling and logistics.

The following summarizes the information you need to determine whether you wish to supplement your experience in my practice by electronically communicating.

General Considerations
Communication via email, text message, or other electronic message will be considered and treated by me with the same degree of privacy and confidentiality as written medical records. I will use reasonable means to protect the security and confidentiality of email sent and received. My phone and computer are password-protected. However, there are known and unknown risks that may affect the privacy of personal health information when using email, text or other electronic means to communicate. These risks include, but are not limited to the following:

  • Standard email communication services (e.g., Gmail, Yahoo, etc.) and cellular service are not secure. This means that the email messages and texts are not encrypted and can be potentially intercepted and read by unauthorized individuals

  • Email and texts can be forwarded, printed, and stored in numerous paper and electronic forms and be received by unintended recipients without my knowledge or agreement

  • Email and texts may be sent to the wrong address by any sender or receiver

  • Email and texts are easier to forge than handwritten or signed papers

  • Copies of email and texts may exist even after the sender or the receiver has deleted his or her copy

  • Email service providers and cellular service providers have a right to archive and inspect messages sent through their systems

  • Emails and texts can be intercepted, altered, forwarded, or used without detection or authorization

  • Email can spread computer viruses

  • Email and text delivery is not guaranteed

Patient Responsibilities

Email messages and texts should not be used for emergencies or time sensitive situations. In the event of a medical emergency, you should immediately call 911. For emergent or time-sensitive situations, you should contact my practice by phone 206.414.8260.

By signing below, you agree that you:

  • will keep messages brief and arrange for an office appointment if the issue is too complex or sensitive to discuss via email or text.

  • will acknowledge that you received and read the message by return email or text to me.

  • understand that it is your responsibility to follow up with me if you have not received a response to my email or text within a reasonable time period.

  • understand that, as stated in the Disclosure and Policy Statement and Fee Agreement, you will be charged a prorated fee for emails in which clinical issues are discussed that require a response from me.