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Please read and sign the wavier below
Concussions, Pain, Mental Health Awareness
Online Support Groups
Informed Consent and Waiver of Liability
Online Support Groups – Overview
Concussions, Pain, Mental Health Awareness (“We”, “we”, “Our”, or “our”) is using Zoom Video Communications, Inc. (ZOOM©) to hold confidential, online support groups. We reserve the right to change the support group platform we use at any time based on new information. You will be informed in advance of any changes that occur.
The Online Support Group will be facilitated by volunteers from Concussions, Pain, Mental Health Awareness. These individuals are not trained medical professionals and will not be providing medical advice or counseling.
Voluntary Participation and Termination
You should only participate in the Online Support Group on a voluntary
basis. You have the right to withdraw from the Online Support Group at any
time. We ask that you inform the group facilitator if you no longer plan to attend
Referral to Alternative Resources
If the group facilitator determines that group telehealth services are inadequate
for the situation and your needs, we reserve the right to provide you a list of services available in your community.
By taking part in the Online Support group, participants may feel a sense of community and connection with others in the group. Participants will hear different opinions and perspectives about alternative and regular treatment options, doctors, etc., some of which might be enlightening or helpful. Participants will have a space to talk openly about themselves and the problems they are struggling with, leading to participants potentially feeling more empowered or in control. The meetings might, also, give participants a feeling of accountability and routine.
Some of the topics discussed may be triggering for participants. If that occurs, participants can speak up, and the facilitators will direct the conversation to a more appropriate topic. Technological risks can include interruptions, unauthorized access or breaches of information, and technical difficulties, all of which CPMHA is not responsible for.
Participants’ Expectations & Guidelines
The facilitators are not trained professionals or counselors. They are not providing medical, or any other type of professional, advice. They are there to facilitate the sessions and offer support. Please know that they are trying to support you.
Understand the goals of the Online Support Group
Share your experiences, emotions, thoughts
Listen and learn about commonalities and differences
Do your part to eliminate the stigma of being open with our mental health and how someone is actually doing
Learn empathy for others’ situations
Break the barrier of isolation and allow others to realize they are not alone in their struggles
Grapple with different life experiences
Learn from others
Do not compare yourself to other participants
Your pain is valid.
Find a new outlet to express yourself, your experiences, and your emotions
Come whenever you can as there is a flexible schedule
Remember that this is a judgement-free zone and open-mindedness is key
Learn to be comfortable talking about the uncomfortable
Let others speak and do not dominate the conversation
Know you are not alone
Root for others’ recovery and wellbeing
There will be no tolerance for poor behavior, including but not limited to:
Bullying, any inappropriate behavior (sexual or pranking), lack of respect for others, and
Usage of substances such as alcohol or drugs before and during a meeting.
Confidentiality is the anchor of mutual support. By creating and maintaining trust with each other, we can share, support and heal more deeply.
I understand that in an online support group, group members will be expected to uphold one another’s confidentiality. I understand that all information disclosed within a session is confidential and may not be revealed by me about other members. The group facilitator cannot reveal information about me without my written permission except where disclosure is required by law:
If I present an imminent threat to myself or others.
When there is an indication of abuse of a child, elder or dependent adult
If I become gravely disabled
By court subpoena
Release, Waiver, and Hold Harmless
By signing below, I hereby release and discharge Concussions, Pain, Mental Health Awareness, their staff, officers, Board of Directors and their volunteers (“the Released Parties”) from any and all claims that may arise from any cause whatsoever in connection with my participation in their Online Support Group. I further release the Released Parties from any liability for any accident, illness, injury, death, loss or damage to personal property, or any other consequences arising or resulting directly or indirectly from my participation in the Online Support Group. I acknowledge the Released Parties assume no responsibility for any liability, damage, injury or death that may be caused by my negligent or intentional acts or omissions committed prior to, during, or after participation in the group telehealth services, or for any liability, damage, injury or death caused by the intentional or negligent acts or omissions of others. I agree to indemnify, defend, and hold harmless the Released Parties from any injury, loss or liability including reasonable attorneys’ fees and/or any other associated costs, from any action, claim, or demand in connection with my participation in the Online Support Group.
By completing and signing this form:
I confirm that I have read and fully understand the above, I have contacted Concussions, Pain, Mental Health Awareness with any questions I have and all of my questions have been answered to my satisfaction. I further agree to adhere to the responsibilities contained herein.
I authorize the Concussions, Pain, Mental Health Awareness volunteer facilitators to send invites to the platform and materials for the Online Support Group to the email I have provided. I am aware that there may be additional charges from my internet and/or phone provider and I do not hold Concussions, Pain, Mental Health Awareness accountable for those charges.
For the purposes of maintaining the safety of myself and others, I consent to provide my phone number, email address, physical address at which I connect to services, and an emergency contact. I also consent to this information being shared with the facilitators.