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Dr. Dustan A. Barabas, P.C.

Clinical Psychologist

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Call 570.629.4900 Today! | 930 N. 9th Street, Stroudsburg, PA 18360
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  • Home
  • About
    • News/Media
  • Associates
  • Rates
  • Services
    • Informed Consent
    • Diagnostic Assessment
    • Individual Psychotherapy
    • Couples & Marital Therapy
    • Group Therapy
    • Clinical Consults
    • Psychological Testing
    • House Calls
  • Supervision
  • Act 235
  • Contact

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Call 570.629.4900 Today! | 930 N. 9th Street, Stroudsburg, PA 18360

Informed Consent for Telepsychological Services

Download Informed Consent Form [PDF]

  • There are potential benefits and risks of video-conferencing (e.g. limits to patient confidentiality) that differ from in-person sessions.
  • Confidentiality still applies for telepsychology services, and nobody will record the session without the permission from the others person(s).
  • We agree to use the video-conferencing platform selected for our virtual sessions, and the psychologist will explain how to use it.
  • You need to use a webcam or smartphone during the session.
  • It is important to be in a quiet, private space that is free of distractions (including cell phone or other devices) during the session.
  • It is important to use a secure internet connection rather than public/free Wi-Fi.
  • It is important to be on time. If you need to cancel or change your tele-appointment, you must notify the psychologist in advance by phone or email.
  • We need a back-up plan (e.g., phone number where you can be reached) to restart the session or to reschedule it, in the event of technical problems.
  • We need a safety plan that includes at least one emergency contact and the closest emergency room to your location, in the event of a crisis situation.
  • If you are not an adult, we need the permission of your parent or legal guardian (and their contact information) for you to participate in telepsychology sessions.
  • You should confirm with your insurance company that the video sessions will be reimbursed; if they are not reimbursed, you are responsible for full payment.
  • As your psychologist, I may determine that due to certain circumstances, telepsychology is no longer appropriate and that we should resume our sessions in-person.

Download Informed Consent Form [PDF]

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930 N. 9th Street, Stroudsburg, PA 18360

Patient Registration

Telehealth Consent

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If you want to register click the button below to complete the Patient Registration form.

Patient Registration

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