- If I choose to change one or both collaborators listed above, or if applicable contact information changes, I will inform my teletherapy counselor and request to sign a new informed consent form.
- If I show signs of deterioration that indicate I may be in danger, I grant VUJ CO staff permission to contact me by an alternate form of technology (such as phone) and/or to contact my collaborator(s) listed above to verify my well‐being. If I show indicators that I may be at serious risk for harm to self or others, I understand that the VUJ CO is required to contact campus staff and/or emergency response personnel to ensure my safety.

Consent for Teletherapy Treatment