COMMUNICATION BY NON-SECURE MEANS

Please  be  informed  that  communication  by  email,  text  message  or  other  electronic  methods  of  communication including Zoom Conferencing  are  not,  in  their typical form, Hipaa compliant means of communication. If you use thesemethods to communicate with me, there is a potential for interception  by  a  third party of these  messages  or interactions,  including  people  in  your  home  or  other  environments  who can  access  your  computer,  phone,  or  other  devices  that you use  to  read  and  write  messages;  your  employer,  if  you  use  your  work e-mail  to  communicate  with  me;  and  third parties on  the  Internet  such  as  server  administrators.

Zoom is considered a secure platform, complete with specified group meeting links, registration and password requirement for virtual individual and groups sessions. 

CONSENT FOR TRANSMISSION OF PROTECTED HEALTH INFORMATION BY NON-SECURE MEANS

I consent to allow Pearl Waldorf to use unsecured email and text messaging to transmit to me the following protectedhealth information: (1) information related to the scheduling of appointments, (2) information related to billing and  payment and (3) therapy processes as discussed and agreed upon. To protect my (and potentially others’) confidentiality, I consent to participate in individual (and/or group sessions) via Zoom in a private location away out of hearing range of others.

I   have  been  informed  of  the  risks,  including  but   not   limited  to  my  confidentiality  in  treatment,  of  transmitting  myprotected health information by unsecured means.