Support Group Registration

Please read and consent to the terms of the Support Group

I hereby consent to engaging in grief related group support via Microsoft Teams.

I understand that group support may include the practice of grief support and education using interactive audio, video, or data communications.

I understand the following with respect to Tabitha Support Group:

• I understand that there are risks and consequences from distance support groups, including, but not limited to, the possibility, that despite reasonable efforts on the part of the group facilitator, that: the transmission of confidential information could be disrupted or distorted by technical failures. These risks are offset by the use of GoToMeeting, a HIPAA-compliant service which is encrypted for video health communications. Further, the contents of my group facilitator’s computer are encrypted.
• In addition, I understand that virtual support may not yield the same results nor be as effective as face to-face service. 
• In emergencies, in the event of disruption of service, or for routine or administrative reasons, it may be necessary to communicate by other means, including telephone or secure email. I understand that non-encrypted email is not secure and should not be used to convey HIPAA protected information.
• It is my responsibility to maintain privacy on the group member end of communication. This includes NOT recording support group sessions. It also includes not using the chat/typing feature during sessions.
• I understand that there are potential limits and benefits associated with any form of support group despite good intentions. I understand that the support group facilitator may suggest the further support of a licensed professional and that I could ask for a referral if the support group does not seem adequate for my needs.
• I acknowledge, however, that if I am facing or if I think I may be facing an emergency situation that could result in harm to me or to another person; I agree to seek care immediately through my own local health care counselor or at the nearest hospital emergency department or by calling 911.