Informed Consent for Complementary Consultation

By scheduling your complimentary consultation with Ryan Baker-Barrett, MS, BCBA, founder of Applied Behavioral Health Practice (Provider), I agree to these terms and conditions.

Nature of Telehealth Services

Through a secure, interactive video connection, I will consult with Provider regarding concerns about myself, my dependent minor child, student, client, or other individual under my care. Provider uses HIPAA-compliant platforms (Microsoft Teams or Healthie) for these consultations.

Potential Risks of Telehealth

I understand the following potential risks associated with telehealth technology:

• The video connection may fail to establish or may disconnect during the consultation
• Video or audio quality may be insufficient for an effective consultation
• If conducted in a non-private location, confidential health information may be overheard or observed by others

Benefits of Telehealth

I acknowledge the following benefits:

• Elimination of travel requirements
• Access to specialized consultation services
• Convenience and flexibility in scheduling

Scope and Limitations of Services

I understand and acknowledge that:

• This complimentary or reduced-cost consultation is for informational purposes only and does not constitute medical, clinical, or professional advice
• No formal client-provider relationship exists or is being established through this consultation
• Provider is not providing billable professional services during this consultation
• Information discussed should not replace advice from a licensed professional in the relevant field
• I am solely responsible for seeking appropriate professional guidance for my specific situation
• Provider is not liable for actions taken or decisions made based on information provided during this consultation

Mandatory Reporting Requirements

I understand that nothing in this agreement supersedes Provider's legal obligations regarding mandatory reporting, including but not limited to:

• Child abuse or neglect
• Elder abuse
• Threats of harm to self or others
• Any other situations required by law

Professional Ethics (If Applicable)

If this consultation involves professionals such as RBT®, BCBA®, BCaBA®, or BCBA-D®, I agree to adhere to applicable ethical requirements of my licensing board, including the BACB® Ethics Code for Behavior Analysts.

Scheduling and Cancellation Policy

• To modify a scheduled consultation, I will contact Provider by email or phone
• For changes requested less than 24 hours before the scheduled consultation, I will contact Provider by phone

Consent

By proceeding to the booking page, I acknowledge that I have read and understood this document, including the risks and benefits of telehealth consultation. My questions regarding the procedure have been answered to my satisfaction. By joining the telehealth consultation, I hereby consent to participate under the conditions described herein.

AGREE AND SCHEDULE 30 min

AGREE AND SCHEDULE 60 min