I understand that:

• This assessment is for clinical purposes and not for forensic or legal testimony.

I understand that:

• Services are provided via secure video conferencing.
• I have the right to withdraw consent for telehealth at any time.
• Telehealth may not be appropriate for all clinical situations.

Testing conditions are essential for accuracy:

• The environment must be quiet and free from distractions.
• No outside assistance or resources may be used during testing.
• Recording of testing sessions is strictly prohibited.
• A stable internet connection and functional camera/microphone are required.

I understand these limitations:

• Technical failures may interrupt or delay the session.
• Privacy cannot be guaranteed if the client's environment is not secure.
• Remote assessment may lack some nuances of in-person interaction.
• Emergency response may be delayed due to physical distance.

I acknowledge that:

• I must provide the exact physical location of the client during each session.
• An emergency contact must be available and reachable during the session.
• The provider will contact local emergency services if a crisis occurs.

I understand that:

• Participation in this assessment is entirely voluntary.
• I may withdraw my consent and stop the assessment at any time.
• Withdrawal of consent will not affect future access to services.

I agree that:

• My typed name below constitutes my legal signature.
• This electronic signature has the same legal effect as a handwritten one.
• I have read and understood all sections of this authorization form.