The counselling session may be a video teleconsultation / teletherapy and I understand/ declare that, 1) I am not minor and my age is above 18 years. 2) The information I provide during the teleconsultation/ teletherapy will be kept confidential. 3) I authorize host of counselling session to record part or whole of the conversation. 4) I am not permitted to record part/ whole of the session. 5) I have the right to discontinue the teleconsultation/ teletherapy at any point during the call. 6) The advice given to me is only based on the accuracy of the information I provide, as direct assessment is not possible. 7) The teleconsultation/ teletherapy is not permitted for any medico-legal purposes. The technology/tele-counselling/tele-therapy/ tele-consultation provider disclaims any liability or responsibility, of harm or injury happening due to misinformation, misrepresentation, misinterpretation and impersonation. I ACCEPT above-mentioned consent terms, conditions and disclaimers. I GIVE MY CONSENT for the counselling session with Dr. Deepti Priya (this consent will be sent via mail by clicking [I Agree] on this form).
Dr. Deepti Priya (PhD Psychology)
