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​Confidentiality Form

  • I understand and agree to maintain confidentiality regarding all discussions and information shared while participating in the psychoeducation and support group for family members of individuals with dissociative disorders. I acknowledge that confidentiality is crucial for fostering trust and creating a safe and supportive virtual environment for all participants.
     

I acknowledge and agree

  • I will ensure that I am in a private and secure location while in support group to protect the confidentiality of all participants.

       I acknowledge and agree

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  •  I will not record, screenshot, or otherwise capture any part of the support group meetings without explicit permission from all participants and facilitators.

       I acknowledge and agree

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  • I will not share any content or discussions from the support group with individuals outside of the group.

       I acknowledge and agree

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  • I will respect the privacy and confidentiality of my family member and will refrain from discussing any identifying details or sensitive information about them during support group.

      I acknowledge and agree

 

  • I understand that this group is intended for educational and supportive purposes only and is not a substitute for therapy. It is not intended to provide counseling, diagnosis or treatment of mental health disorders. I understand that it is my duty to seek out further mental health services if I feel the need for more individual support.

      I acknowledge and agree

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  • I understand that while the facilitators will make every effort to maintain confidentiality, there are limitations to confidentiality, particularly in cases where there is a risk of harm to oneself or others. In such instances, the facilitators may be obligated to disclose information to appropriate authorities or take necessary steps to ensure safety.

       I acknowledge and understand

 

  • By signing below, I affirm that I have read, understood, and agree to abide by the terms of this confidentiality agreement throughout my participation in the telehealth psychoeducation and support group.

Thanks for submitting!

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