Telehealth Informed Consent, Website AI Assistant Disclosure & Crisis Notice

Telehealth services described in this Part A are provided by Joselyn Vasquez, LISW-S ("Clinician"), a Licensed Independent Social Worker with Supervision Designation and a health care professional under Ohio law (Ohio Rev. Code § 4743.09(A)(3)(k)), licensed by the Ohio Counselor, Social Worker, and Marriage and Family Therapist Board, Ohio License No. 1440311. You may verify this license at any time, free of charge, at the Board's online license verification site — https://elicense.ohio.gov/oh_homepage — which is linked from this Site's footer consistent with Ohio Administrative Code 4757-5-13(M)(5).

Ohio law authorizes an independent social worker to provide behavioral health services by telehealth (Ohio Rev. Code §§ 4743.09, 4757.50). "Telehealth" (sometimes called "teletherapy") means delivering services using live, synchronous, interactive audio and/or video technology in place of an in-person visit (Ohio Admin. Code 4757-5-13(A)). Ohio does not require an initial in-person visit before telehealth begins (Ohio Admin. Code 4757-5-13(C)).

Plain language: Ohio law lets Joselyn see clients over live video or phone instead of in person, without an in-person visit required first — as long as the rules in the rest of this Part A are followed.

The Clinician is licensed to practice independent social work in the State of Ohio, and holds no license or other authorization to practice in any other state.

Under Ohio's teletherapy rule, the law that governs a session is the law of the place where you are located when the session happens — not the place where the Clinician is located. A licensee serving a client who is physically present in Ohio must be licensed in Ohio (Ohio Admin. Code 4757-5-13(A)(1)), and a licensee serving a client located outside Ohio "shall comply with the laws and rules of the jurisdiction where the client is located at the time services are rendered" (Ohio Admin. Code 4757-5-13(A)(2)). Every other state regulates who may deliver behavioral health services to a person sitting inside its borders, and the Clinician is not authorized under any of those regimes.

For that reason, the Practice requires that you be physically located within the State of Ohio at the time of every telehealth session. This is the Practice's policy, adopted so that every session is delivered under the one body of law the Clinician is authorized to practice under.

At the start of each session, you will be asked to confirm your physical location, consistent with Ohio Admin. Code 4757-5-13(O). If you are outside Ohio when a session is scheduled to begin — including while traveling — the session will not proceed as telehealth. Depending on timing and availability, it will need to be rescheduled for a time when you are back in Ohio or, if in-person services are available, converted to an in-person appointment.

If you relocate outside Ohio on a long-term or permanent basis, the Clinician may be unable to continue providing you services and will provide referral information consistent with applicable continuity-of-care standards.

If the Clinician's authorization to practice changes — for example, if she becomes licensed or otherwise authorized to practice in another state — this policy will be updated accordingly. Ask the Practice if your circumstances change.

Plain language: the rule that matters is the law of wherever you are sitting during the session. Joselyn is licensed in Ohio and only Ohio, so the Practice's policy is that your sessions happen while you are physically in Ohio. If you are somewhere else when your session is set to start — even briefly, even on a trip — it will not go ahead as telehealth that day.

Telehealth services must meet the same standard of care as in-person services (Ohio Rev. Code § 4743.09(B)(2)(a)). Telehealth is a different way of delivering care, not a lesser one — but it carries its own risks and limitations, described in A.6 below.

To participate in a telehealth session, you will need:

• a reliable internet connection (broadband/Wi-Fi recommended over cellular data where possible);
• a device with a working camera and microphone (computer, tablet, or smartphone) capable of running TheraNest Telehealth, the platform the Practice uses for telehealth sessions;
• an up-to-date browser or app, as required by that platform;
• a private, quiet space where you will not be interrupted or overheard, for the full length of the session; and
• a charged device, or one connected to power, for the duration of the session.

Ohio law requires that usernames, passwords, and electronic communications used for telehealth be transmitted and stored securely (Ohio Rev. Code § 4743.09(C)(3)); the Practice selects its telehealth platform with that requirement in mind. Headphones are recommended for additional privacy, particularly if you cannot guarantee a fully private space.

Plain language: you need a stable connection, a working camera/mic, a private room, and a charged device. Bring headphones if you are worried about being overheard.

Telehealth may offer: improved access to care and continuity of care during travel, illness, or scheduling conflicts; reduced travel time and associated costs; and increased scheduling flexibility, consistent with the Practice's hours (Monday–Saturday, 9:00 a.m.–9:00 p.m.).

• Technology failure. Interruptions, poor connectivity, or technical malfunctions may disrupt or delay a session (see A.7).
• Confidentiality risk. No electronic transmission is completely free of the risk of interception or unauthorized access, notwithstanding the safeguards described in A.4. You are also responsible for the privacy of your own environment and device.
• Clinical limitations. The Clinician cannot observe the same nonverbal and environmental information available in person, which may affect clinical assessment. Telehealth may not be appropriate for every clinical presentation, including some crisis, safety, or acute-risk situations.
• Emergency-response limitations. The Clinician's ability to respond to an emergency during a telehealth session is more limited than in person (see A.8).

If video or audio is lost during a session:

1. 1Both you and the Clinician will attempt to reconnect through the same platform for a brief period.
2. 2If the connection cannot be restored, the Clinician will attempt to reach you by phone at the number on file, either to continue the session by phone or to reschedule if that is not possible.
3. 3If you cannot be reached and the Clinician has any concern about your immediate safety, the Clinician may contact your designated emergency contact or emergency services, consistent with A.8 below.
4. 4An interrupted session will be noted in your record. Any rescheduling or billing adjustment will be handled consistent with the Practice's fee schedule (https://queztherapy.com/fees) and the Terms of Use.

A connection failure is not a crisis-response plan. If you are experiencing a mental health emergency at any point during a disrupted session, do not wait for reconnection — call or text 988, text HOME to 741741, or call 911 immediately.

Plain language: if the call drops, we will try to reconnect, then call your phone. If we cannot reach you and there is a safety concern, we may contact your emergency contact or 911. If it is a real emergency, do not wait on us — call 988 or 911 yourself, right away.

Because the Clinician is not physically present with you during a telehealth session, before telehealth services begin — and periodically thereafter — you will be asked to provide: (a) the physical address where you will be located during each session; and (b) the name and contact information of a local emergency contact, consistent with the crisis and after-hours access information required by Ohio Admin. Code 4757-5-13(M)(7). At the start of each session, you will also be asked to confirm your current physical location (Ohio Admin. Code 4757-5-13(O); see A.2).

If you experience a mental health emergency — during a session, between sessions, or during a connection failure — stop and:

• Call or text 988 (Suicide & Crisis Lifeline, 24/7)
• Text HOME to 741741 (Crisis Text Line, 24/7)
• Call 911, or go to the nearest emergency room

If you communicate a threat to another person. If, based on your communications, the Clinician believes you present an explicit, credible, and imminent threat of serious physical harm to a clearly identifiable other person, Ohio Rev. Code § 2305.51 defines the actions available to her in response. The statute sets out several alternatives — which may include communicating the threat to a law enforcement agency with jurisdiction and, if feasible, to each potential victim; pursuing hospitalization; or establishing a documented treatment plan reasonably calculated to prevent the threat from being carried out, together with a concurrent second-opinion risk assessment. Ohio law requires the Clinician to consider each alternative and to document the reasons for choosing or rejecting each one (Ohio Rev. Code § 2305.51(C)(1)). Which action she takes depends on the circumstances; this document does not promise any particular one.

If the Clinician believes you are at risk of serious harm to yourself. This situation is not governed by § 2305.51, which addresses threats to other people. If the Clinician believes you are at imminent risk of serious harm to yourself, she will act consistent with her clinical judgment and her professional and ethical obligations as a licensed independent social worker. Depending on the circumstances, that may include contacting your emergency contact or emergency services, or seeking emergency evaluation or hospitalization under Ohio's emergency-hospitalization framework (Ohio Rev. Code § 5122.10).

Further detail on confidentiality and its limits, including mandatory reporting, is provided in the HIPAA Notice of Privacy Practices.

Plain language: we will ask for your address and an emergency contact before starting telehealth, and confirm where you are at the start of every session, because Joselyn cannot see your surroundings the way she could in person. If there is ever a genuine safety concern, she can act on it — which could include contacting 911, your emergency contact, or law enforcement. Ohio law is specific about what she may do when someone is threatened, and it requires her to weigh the options and write down why she chose the one she chose.

Telehealth sessions are confidential to the same extent as in-person sessions, subject to the same limits described in the HIPAA Notice of Privacy Practices (including mandatory reporting and the duty-to-warn/protect limits described in A.8 above). Neither party may audio- or video-record a session without the other party's prior written consent, except as otherwise required by law.

Consistent with Ohio Admin. Code 4757-5-13(J), any therapeutically relevant email, text, or chat message becomes part of your clinical record. Because of this — and because the Practice does not publish or monitor a general email address (see the Terms of Use) — please raise clinically significant matters directly in session or by phone at 330-203-1559, not by message.

Telehealth sessions are billed on the same basis as in-person sessions — through your in-network insurance benefits where the Practice is in-network with your plan, or otherwise at the Practice's self-pay rates ($145 initial session; $135 ongoing sessions) — as published at https://queztherapy.com/fees. No separate facility fee is charged for telehealth (Ohio Rev. Code § 4743.09(E)(1)). You will be asked to consent to how telehealth sessions are billed before billing begins (Ohio Rev. Code § 4743.09(E)(3); Ohio Admin. Code 4757-5-13(M)(2)). Cancellation and no-show terms, and Good Faith Estimate information under the federal No Surprises Act, are set out in the Terms of Use and are not restated here.

You may request in-person services, if offered by the Practice, or a referral to another provider offering in-person care. You may discontinue telehealth and switch to another modality at any time, subject to availability, by notifying the Practice.

Before receiving telehealth services, you will be asked to review and acknowledge this Part A — typically through a signed or e-signed acknowledgment completed at intake through the client portal. By acknowledging this Part A, you confirm that you have read and understand it, that your questions have been answered, and that you voluntarily consent to receive services by telehealth on the terms described above. This consent is also the consent contemplated by Ohio Rev. Code § 4743.09(D), and you should understand what that provision does. Under it, when a patient has consented to receiving telehealth services, the health care professional is not liable in damages under any claim made on the basis that the services do not meet the same standard of care that would apply if the services were provided in person.

That protection is narrow and specific to the telehealth modality itself. It does not immunize the Clinician against negligence in how care is actually delivered, and it does not change her obligation to meet the standard of care that applies to telehealth services, which Ohio law requires to be equal to the in-person standard (Ohio Rev. Code § 4743.09(B)(2)(a); see A.3). In plain terms: consenting to telehealth means you accept the risks and limitations of the modality described in A.6 — it does not mean you accept careless care, and nothing in this document asks you to.

You may withdraw this consent at any time, effective for future sessions, by notifying the Practice.

The Website AI Assistant is an automated chat feature on this website that answers general, non-clinical questions — such as office hours, general fee information, how to request an appointment, and general questions about the Practice's areas of focus — and helps route scheduling requests to the Practice's scheduling platform. It operates under the direction of Joselyn Vasquez, LISW-S, the Practice's Clinician, who is responsible for what the Assistant is configured and permitted to do, and who remains fully responsible for all clinical care provided by the Practice.

The Website AI Assistant is not:

• Joselyn Vasquez, LISW-S, or any other licensed clinician — it will not identify itself using any title reserved for a licensed health care professional (e.g., "therapist," "counselor," "social worker," "psychologist," "psychiatrist," or "LISW-S");
• therapy, counseling, psychotherapy, diagnosis, treatment, or clinical or medical advice of any kind;
• a crisis service, an emergency service, or a substitute for calling or texting 988 or calling 911;
• confidential in the HIPAA sense — using it does not create a treatment relationship or a HIPAA-protected record, and it is not a HIPAA-secure communication channel;
• a place to put health information — do not type your symptoms, a diagnosis, medications, treatment history, or anything else about your health into it;
• monitored in real time by clinical or administrative staff;
• part of your clinical record, unless and until Practice staff manually and separately incorporate relevant scheduling information into that record after human review;
• designed or used to detect, infer, or analyze your emotions or mental state; or
• a decision-maker — it does not make independent clinical or treatment decisions.

These boundaries reflect the Practice's own policy and are consistent with the substance of AI-in-mental-health statutes enacted elsewhere in 2025–2026 — including Illinois (225 ILCS 155/20(b)(1),(4) (Illinois Public Act 104-0054)), Nevada (AB 406 (2025), Sec. 7(1)-(2), Sec. 8(1)), Utah (Utah Code § 13-72a-101(10)), and California (Cal. Bus. & Prof. Code § 22601(b)(2)(A)) — which the Practice follows nationwide, for every visitor, for the reasons explained in B.7 below.

Plain language: the chat widget is a bot, not a person and not your therapist. It can help with logistics — hours, fees, scheduling. Do not tell it anything clinical, sensitive, or urgent, and do not use it in a crisis.

Before you can use the Assistant's features, and at the start of any new conversation, the Site will clearly disclose that you are interacting with artificial intelligence technology, not a human being, and that the Assistant is limited to scheduling, fees, hours, and general practice information — not therapy, and not a confidential channel. If you ask the Assistant whether it is artificial intelligence, it will confirm that it is (Utah Code § 13-72a-203(1)-(2); Cal. Bus. & Prof. Code § 22602(a)).

A disclosure substantially in this form is shown before you can send your first message:

Do not use the Website AI Assistant to report a crisis, an emergency, suicidal or homicidal thoughts, abuse, or any situation requiring immediate attention. If a message you send indicates a possible crisis or safety concern, the Assistant is designed to stop, decline to engage further with that content, and immediately present the same fixed crisis resources every time — call or text 988, text HOME to 741741, or call 911 — rather than attempt to assess, respond to, or continue discussing it. See Part C for full detail; this design choice is explained further in B.7.

Nothing generated by the Website AI Assistant modifies, supplements, or overrides your treatment plan, the Clinician's advice, or the terms of Part A above. If the Assistant ever suggests that you schedule with the Practice, that suggestion is informational only (permissible consistent with Utah Code § 13-72a-202(3)) — it is not, and is never permitted to be, a clinical recommendation.

The Website AI Assistant is powered by artificial-intelligence technology operated by a third-party service provider under contract with the Practice, which processes the content of your conversation with the Assistant in order to generate responses. The Practice does not have a HIPAA Business Associate Agreement with this AI service provider. The Assistant is not configured, and must not be used, to receive, process, or store Protected Health Information or any clinical, diagnostic, symptom, or crisis-related information. Do not enter such information into the Assistant. Nothing you type into it becomes part of your clinical record unless and until Practice staff separately and manually incorporate relevant scheduling or logistical information into that record after human review. See the Privacy Policy for further detail on how Assistant conversations are handled, and why nothing you type is stored on the Practice's servers.

Illinois, Nevada, Utah, and California have each recently enacted statutes addressing the use of artificial intelligence in connection with mental health services, or AI chat features more generally. The provisions of those statutes that regulate licensed professionals are keyed to licensure in that state — they do not, on their face, reach an independent social worker licensed only in Ohio. Several of them also exclude tools used only for customer service, scheduling, or administrative support, which is consistent with how the Website AI Assistant is built and used here.

Because this website is reachable from anywhere, and because the Practice believes clear disclosure is simply the right way to run an automated tool anywhere near sensitive subject matter, the Practice has voluntarily adopted — for every visitor, regardless of location — the practices described in this Part B, including:

• disclosing, before you can send a message and at the start of each new conversation, that you are talking to AI and not a person (Utah Code § 13-72a-203(1)-(2); Cal. Bus. & Prof. Code § 22602(a));
• designing the Assistant so that it does not attempt to detect, infer, or analyze your emotions or mental state (225 ILCS 155/20(b)(4));
• ensuring the Assistant never represents, and is never permitted to represent, that it is a licensed mental or behavioral health provider, or that interacting with it is equivalent to receiving care from one (Nevada AB 406 (2025), Sec. 7(1)(a)-(c));
• prohibiting the Assistant from identifying itself by the Clinician's name, by the title "LISW-S," or by any other term implying that it is a licensed health care professional — each such use would be treated as a separate violation under California law had this Practice been a California one (Cal. Bus. & Prof. Code § 4999.9(c)-(d)). The Assistant may of course tell you who the Clinician is and suggest that you book a session with her; what it may never do is present itself as her, or as any licensed professional (see B.2); and
• publishing the fixed crisis-response design described in Part C, in the form California law requires for a "companion chatbot" (Cal. Bus. & Prof. Code § 22602(b)), regardless of whether the Website AI Assistant meets that statute's definition.

This voluntary approach means you receive the same protections described in this Part B no matter where you are when you visit this website. Whether Ohio has enacted, or will enact, a statute comparable to those above has not been independently confirmed as of the Effective Date above; the Practice's policy in this Part B does not depend on the answer.

This website and the Website AI Assistant are not directed to children under 13, consistent with the Privacy Policy. If you are a parent or guardian using the Assistant on behalf of a minor, the same limits apply: scheduling and general information only, never clinical detail.

The Website AI Assistant cannot guarantee real-time or same-day response. For anything time-sensitive, clinically significant, or requiring a person, contact the Practice directly:

• Phone: 330-203-1559, during office hours (Monday–Saturday, 9:00 a.m.–9:00 p.m.)
• Website contact form: https://queztherapy.com/contact (expect a delay; not for urgent matters)
• Established clients: use the client portal

If the matter is urgent and you cannot reach the Practice, use the crisis resources in Part C rather than waiting on the Assistant or the contact form.

This website — including its general content, scheduling functionality, and the Website AI Assistant — is not an emergency service, is not staffed or monitored in real time, and cannot respond to a crisis.

If you are in crisis, please reach out right now.

• Call or text 988 — the 988 Suicide & Crisis Lifeline. Free, confidential, 24/7.
• Text HOME to 741741 — Crisis Text Line. Free, 24/7.
• Call 911 if you or someone else is in danger or needs immediate medical attention.

You can also chat with the 988 Lifeline at chat.988lifeline.org.

Quez Therapeutic Solutions, LLC is not a crisis service. Our office is open Monday through Saturday, 9:00 a.m.–9:00 p.m., and we cannot respond to emergencies. If this is an emergency, use one of the resources above. When you are safe, we are here for what comes next — call 330-203-1559 or use the contact form.

If a message you send to the Website AI Assistant indicates a possible crisis, suicidal or homicidal thoughts, self-harm, or another safety concern, the Assistant is instructed to stop, decline to engage with or elaborate on that content, and immediately present the crisis resources above — the same way, every time. The Assistant is not built or permitted to detect, evaluate, or respond to a mental health crisis (see B.2, B.4, B.7); a fixed, unchanging crisis message is safer than an improvised one.

Contact the Practice directly at 330-203-1559 during office hours (Monday–Saturday, 9:00 a.m.–9:00 p.m.), or through the client portal. If you cannot reach the Practice and the matter feels urgent, use the crisis resources above rather than the Website AI Assistant or the website contact form — neither is monitored in real time or appropriate for an urgent or emergency matter.

Neither this website nor its Website AI Assistant is an emergency or crisis service, a therapist, or a substitute for professional care. If you are experiencing a mental health emergency, stop using this website and call or text 988, text HOME to 741741, or call 911 immediately.