WHAT TO EXPECT IN A SESSION AND CONSENT TO PROVIDE SERVICE
What to Expect in a Session with Adapt 2 Healing LLC First,
I will ask to confirm your Identity, (you may provide it ID by email, or a screen shot may be taken.
The sessions are private and confidential we do not report your information to any agency.
If you are receiving services through FAPT or under a caseworker, we will file a weekly or monthly report of progress all information will be disclosed to you.
There may be note taking so that the provider can reflect as needed, provide you with a copy of what was discussed for reference, and to build a personal plan and or obtain needed resources.
You may be welcomed and made as comfortable as Possible ( you may hear environmental noise from outside of the space )
You may be provided the agenda (if it’s required)
Your Relatable Peer will take your lead in the discussion
You may not be given unsolicited advice (we are not therapist)
We may respect your choice, we may not judge
We are Mandated reporters; We will discuss with you our concerns if there is a need to call (crisis or emergency) for support if We hear distressing words or phrases that suggest harm or danger to you or family in the home.
You may be asked open ended questions for clarity
We will share parts of our lived experience with you
You may be triggered by talking through or hearing similar lived experiences or by reliving past experiences (This is normal, and we will work with you through it)
You May contact emergency services for support, we may contact emergency services to support you
You May feel Relief or a load lifted off your shoulders after the session
You may want to learn more information and resources that can help support you and your family
You may be given Hope and Positive Motivation
CONSENT TO PROVIDE SERVICES AND LIABILITY WAVIER
Participants Email that will be used to verify this form:
Services provided by Adapt 2 Healing LLC Digital Peer / Peer Support/ Family Support
Location of Peer Support Provider: VIRGINIA
Purpose: The purpose of this form is to obtain your consent to participate in a Digital Peer Support visit in connection with the following service(s) and/or procedure(s): Peer Support/ Family Support Sessions One on one/ Group Sessions/ and other Services Provided Digitally/ Virtually by Adapt 2 Healing LLC Providers.
Scope and Limitations: Digital Peer Support and Services visits are not Fulfill all Mental Health / Physical Health needs. Your Provider will support you in determining which Digital Support service(s) and/or processes (s) are appropriate for you.
Confidentiality and Security: All information given at your Digital Support visit will be kept and protected in full compliance with federal and state privacy laws. Efforts, including not limited to the following: training staff to the proper procedures and process for handling Participants information, using secured and encrypted, platforms as available including cloud-based, updating/patching of software as updates are available, and encryption and password-protected data drives and folders) have been made to keep your information confidential. No system is flawless. You (the participant) agree that technological failures may occur. Some or all of your information may be electronically lost or breached. The Digital Peer visit may also be interrupted or canceled due to technical failure(s).
Medical Records: All federal and state laws about access to your medical records apply to Digital Peer Support. You may request access to your records.
Rights: You may opt-out of the Digital Peer Support visit at any time. This will not change your right to future care or health benefits.
Risks and Consequences: You have been advised of the potential risks and benefits of Digital Peer Support visits. You have had a chance to ask questions about the Digital Peer Support visit. You have received satisfactory answers to your questions. You are in understanding that Adapt 2 Healing LLC and its members are not and will not be or made to be liable at all including events and or outcomes as it pertains to you and others receiving and not receiving services.
By agreeing to this form checking the box and signing, you agree to the above terms, and you (the Participant) agree that you understand the information in this form.