AFTC Electronic Communication and Remote Therapy Consent This field is hidden when viewing the formGUIDThis field is hidden when viewing the formreqCodeThis field is hidden when viewing the formuserEmail This field is hidden when viewing the formSubmission Date (Admin Only) DD slash MM slash YYYY We are committed to supporting the ongoing health and wellbeing of our clients, staff and community. In response to the spread of Coronavirus (COVID-19) in Manitoba, we are following guidelines for best practices from local, national and international health authorities. As a result, we are taking additional measures to ensure that clients are kept safe, which includes offering remote therapy sessions as an alternative to face-to-face meetings. All remote therapy sessions will comply with the AAMFT Code of Ethics Standards VI Technology – Assisted Professional Services. These sessions will take place via telephone or Zoom video conferencing. Your privacy is very important to us, and we take great steps to protect your privacy. Electronic communication is becoming the norm in many parts of our lives today and with it come extra concerns about privacy. Therapists and staff at Aurora will not contact you by electronic means without your consent. Electronic communication is any form of communication using electronic means or devices. This includes but is not limited to: Telephone, Video Conferencing, Texting, and Emails, among other forms, whether on a mobile electronic device or a computer (including laptops). Therapists or staff at Aurora may use electronic communication to arrange, cancel or confirm appointments, to provide clients with information about upcoming events or services, and, during COVID-19, we will hold our therapy sessions by telephone or Zoom video conferencing. If you choose to contact us electronically, or consent to us contacting you electronically, you need to know: We cannot guarantee the privacy of electronic communication; Email, cell phones, video conferencing, and other electronic means are not 100% secure or confidential; If you choose not to consent to electronic communication, we may not be able to provide any services at this time, as all therapy sessions are currently being conducted remotely to align with government recommendations and/or orders for social distancing, and minimization of non-essential contact and group gatherings; Should you choose to proceed with remote therapy sessions, electronic communication between you and your therapist or staff at Aurora will become part of your client file, if it is for the purposes of a therapy session. Phone sessions and video conferencing sessions will not be recorded but will be discussed with Aurora Staff and Administrative Team for the purposes of consultation of my work with you, via a video/audio conferencing platform called Zoom; You can revoke your consent to electronic communication and/or remote therapy sessions without penalty at any time, subject to a reasonable notice period. Please be aware, however, that if you choose not to receive electronic communication or not to participate in remote therapy sessions via telephone or video conferencing, that we may no longer be able to provide you services due to the current recommendations for reducing the spread of COVID-19. (Required) * I am aware of the potential security risks with electronic communication and give consent for staff and therapists at Aurora to contact us through electronic means, and for services to be delivered remotely through technology-assisted means. Date Signed(Required) DD slash MM slash YYYY Full Name(Required)Signature(Required)