individual telehealth services can be provided for all clients upon request. Telehealth services are permitted upon client consent to MARS’ “Individual Counseling Telehealth Agreement”. Please see below for MARS Individual Counseling Telehealth Agreement.

MARS/Client Group and Individual Counseling Telehealth Agreement

Welcome to MARS! We look forward to working with you. Please review the following telehealth agreement. Telehealth is the ability to receive treatment services by using technology and does not require you to be in the office for sessions. These guidelines have been established to provide you and others with a therapeutic environment that is safe and welcoming for all. Please review and sign to indicate your commitment to abide by the following:

• I will have my camera on my full face at all times as will the clinician I am working with.

• I will list my name on the telehealth platform to be identified by fellow group members as will my fellow members and clinician during group sessions.

• I will list my name on the telehealth platform to be identified by my counselor during individual sessions.

• I understand Zoom/doxy.me will be utilized during telehealth sessions and services are being rendered via two wayaudio-video transmission.

• I understand the risks of telehealth during a crisis or emergency situation where I would not have immediate access to my counselor and a call to crisis or 911 would take place during my session.

• I understand the privacy risks associated with telehealth services such as the potential for information to be heard by outside parties or the risk of cyber security threats.

• I will be in a quiet and confidential place where no one can hear the conversation or see the members of the group on the screen such as housemates or the general public.

• I will be in a quiet and confidential place in individual sessions with my counselor.

• I will be fully clothed and seated upright as if I were attending counseling in-person at the MARS facility.

• I will not be moving around or multitasking (shopping, driving, texting, scrolling social media, playing video games, watching TV, etc.) while treatment is in session as this may distract from counseling work.

• When I am not speaking in session, I will keep myself muted, if necessary, so that potential background noise/feedback will not disturb what is currently being shared.

• I will silence my phone during session.

• I will respect my fellow group members and counselor by refraining from the following but not limited to: offensive language and behaviors, even when there are differences in opinions, values, or ideas.

• I understand that if I indicate that I intend harm to myself, another person, or report abuse to a child that my counselor will need to report this to the necessary entities.

• I understand that in order to receive counseling services from MARS, I must physically be in the state of Pennsylvania.

• If the location of where I am at the time of session is different than the address I have indicated at the time of my intake, I will private message my counselor my current location in case of emergency.

• I will log on at least 10 minutes before session starts to ensure technology is working properly and I can access the session.

• I understand consistent group and individual attendance is imperative to my treatment success. I understand that if I miss 2 Outpatient groups in a row or 3 Intensive Outpatient groups in a row without communicating with my treatment team OR have a show rate less than 75% this may result in removal from group/dismissal from the program.

• I will communicate to my counselor ahead of time about any absences/lateness to the group. If I do not communicate this, I will be marked as a No Call/No Show and this may result in removal from group/dismissal from the program.

• I understand that if I am late to session over the acceptable grace period, that my counselor may not grant me access to session that day. This also may result in removal from session/dismissal from the program.

• I will adhere to any other group/individual norms established by my specific counselor upon entering the group/individual session.

• I understand I have the right to refuse telehealth and/or receive in-person services at any time.

• I understand the groups will not be recorded without consent from all members.

• I also understand that failure to abide by the above guidelines can lead to removal from group session or ending an individual session early.

I fully understand the above guidelines and have been given the opportunity to discuss any aspects of this agreement with the assessor. I also understand that this is an ongoing agreement and can discuss this with my clinical staff at any time. By signing this, I understand that failure to abide by the above guidelines may result in my treatment team recommending in-person treatment.