PLEASE NOTE: Zoom links will be sent to you via email.  Please keep this email as it has the Zoom link that you will use to attend the meeting

****Please be sure to check your SPAM folder as links sometimes get sent there****

***Zoom Links to the Groups will be sent out at the time you register for a group***

 

Please note: All groups are listed on our website are in EASTERN (New York) TIME. You will need to calculate what time the group is happening in your time zone. No refunds will be given for missed groups. 

PeerVida.com DISCLOSURE STATEMENT AND

GROUP or INDIVIDUAL SERVICES AGREEMENT

This statement is being provided to you so that you are aware of your rights as a support group client. Please read this and discuss any questions or concerns you have before signing it.

INFORMATION
PeerVida, LLC can be reached at hello@peervida.com.

YOUR RIGHTS AND IMPORTANT INFORMATION
A) You are entitled to receive information from PeerVida about our support groups, and the techniques we use (all groups are led by trained mental health professionals and/or trained Peer Support Specialists). The support groups and community groups are open groups, which means individuals can attend groups as they need to or want to.

B) You can drop out of the group at any time, seek therapy, or attend other groups at any time.

C) Generally speaking, the information provided by and to a client in a professional relationship with a group facilitator is considered confidential. There are several exceptions to confidentiality which include: (1) reporting any suspected incident of elder, IDD, and child abuse or neglect to law enforcement; (2) reporting any threat of imminent physical harm by a client to law enforcement and to the person(s) threatened; (3) reporting any suspected threat to national security to federal officials; (5) reporting any threats against locations such as churches, schools, theatres, workplaces, etc. to law enforcement, and (6) group facilitators may be required by Court Order to disclose peer support group information.

D) When we are concerned about a group member’s safety, it is our policy to request a Welfare Check through local law enforcement. In doing so, PeerVida may disclose to law enforcement officials, information concerning our concerns. By reading and agreeing to this Disclosure Statement and agreeing to attend PeerVida group support, you consent to this practice, if it should become necessary.
F) Animal abuse: PeerVida will report animal abuse, including cases of neglect and hoarding.
G) Prenatal Exposure to Controlled Substances: in keeping with protecting vulnerable populations, Mental Health Providers are required to report admitted use of controlled substances during pregnancy that is potentially harmful to the fetus.

FEE INFORMATION: PeerVida's standard fee is $35 for a 50-minute online group support session To attend either type of group, payment must be made at least 60 minutes prior to the scheduled group time. All payments must be made through our point-of-sale software using a credit or debit card. No refunds will be provided for groups that are attended. PeerVida does not accept insurance for services rendered. You understand you are legally responsible for the payment of your support groups. If it is ever necessary, any meetings with auxiliary medical or legal consultants either by phone or in person, report writing, and/or court appearances (as required by a court-issued subpoena) will be billed at $240/hour in advance.

GROUP SIZES: In the event, that there is one (1) attendee in a group, the group will run for 25 minutes, if there are two (2) people the group will run for 35 minutes, and three (3) plus people the group will run for the full 50 minutes. The purpose of groups is not to provide one-on-one support. Groups may be canceled at the discretion of PeerVida if less than three people sign up.

MISSED GROUPS AND CANCELATIONS: If you are unable to attend a group in which you are signed up, please notify PeerVida at least 48 hours in advance via email at MELISSA@PEERVIDA.COM, we will attempt to place you in the next appropriate group. If you are unable to attend the group and have given 48-hour advanced notice and would like a refund, there will be a charge of 8% of the total fee. If you cancel or miss a group meeting without giving PeerVida 24 hours notice, you will forfeit the fee you have paid to attend the group session. Attendees coming to the group 8 minutes after the group has started will not be admitted and no refund will be given. After two missed support group sessions PeerVida reserves the right to terminate services with you. If you are added to a group by a facilitator you agree to either a) allow PeerVida to charge your credit card on file, or if you don't have a credit card on file, b) allow PeerVida to email an invoice to you for payment and you agree to pay the invoice within seven (7) days of receipt. If you have an unpaid balance that is over one week old (seven (7) days), PeerVida reserves the right to exclude you from groups until your outstanding balance is paid.

DRUG AND ALCOHOL POLICY: PeerVida asks that you attend group support meetings sober and drug-free (i.e. not intoxicated with alcohol or high on recreational drugs including cannabis or street drugs.) We ask this as being in a chemically altered state can sometimes be a barrier to the group process. If a PeerVida facilitator becomes aware that you are intoxicated during your support group, we will block you from the group and you will be charged a full group session fee. PeerVida is not responsible for your safety and/or wellbeing if you choose to drive while intoxicated.

PROFESSIONAL CONSULTATION: There may be times when your PeerVida group facilitator(s) may need to consult with a colleague or another professional, like an attorney, mentor, or supervisor about issues raised by you in the group. Your confidentiality is still protected during a consultation between the group facilitator and the professional consulted. Signing this disclosure statement gives PeerVida permission to consult as needed.

ELECTRONIC COMMUNICATIONS: By signing this agreement, you agree to communicate via electronic communications such as telephone, video, text or email, or any other electronic method of communication, we cannot guarantee that those communications will remain confidential due to the nature of such technology or unauthorized monitoring. However, confidentiality does extend to those electronic communications. Also, you agree and understand that for this reason, electronic communications are for business-related or logistical communications, such as scheduling and confirming appointment details and times, and video platforms for peer support groups.

NON-EMERGENT SERVICES: We at PeerVida provide non-emergency support group sessions by scheduled appointment. If for any reason, you are having a true emergency, you agree that you will call 911 or your local emergency number or check yourself into the nearest hospital emergency room. We do not provide after-hours services.

THE NATURE OF SUPPORT GROUP SESSIONS: There are a number of risks and benefits inherent in support group sessions. There may be psychological side effects from support group sessions. This risk comes with any support group. You may share painful things. With time, we hope these potential side effects will lessen and our work together will benefit you. Additionally, there are no guarantees regarding the outcome of support group attendance.

ONLINE VIDEO PLATFORMS:  Currently, PeerVida uses Zoom to provide the online video connections.  Like any online platform, we cannot guarantee that all links, emails, videos, and groups are confidential as, from time to time, there are breaches in security that are beyond our control.  PeerVida makes every effort to use the latest, safest  technology to protect its group members, however, we cannot guarantee confidentiality 100%.

SUPPORT GROUP SESSIONS ARE CONDUCTED ONLINE: PeerVida provides support group sessions using a platform called ZOOM. You will be sent a link prior to your session in which you can log on and where you will wait in the virtual waiting room until your session begins. As an attendee of PeerVida groups you agree that you will NOT record the group's sessions either via audio or video, take photos or take screenshots of the sessions.

CONTACT PERMISSION: Occasionally, via email and text, we send out updates about upcoming groups, newsletters, new groups, upcoming speakers, and other areas of interest. We will always treat your personal details with the utmost care and will never sell them to other companies for marketing purposes. If you would like to opt out of receiving marketing materials from us, please send us an email at hello@peervida.com and ask to be removed from our email list.

ADULTS ONLY: The group that you are registering for is a support group for adults only. By registering for a group, you are acknowledging that you are eighteen (18) years of age or older. PeerVida does not allow anyone under the age of eighteen (18) to attend adult support groups. From time to time, we do conduct support meetings for teens ages 13-17, but this group that you are registering for is not one of them. If you are under 18 and attend one of our adult support groups, the facilitator will turn off your Zoom link and you will not be given a refund for that group.

PeerVida reserve the right to change the terms of this notice and to make the new notice provisions effective for all peer support group session attendees. We will provide you with a revised notice via email if you are currently a client.

PeerVida.com, LLC, Support Groups and Confidentiality Agreement

You understand and acknowledge that you will be engaging in a support group experience in an online format (telehealth via video) which is being provided by PeerVida.com, LLC (PeerVida). A qualified Peer Support Specialist (PSS), trained life coach, or an experienced facilitator/consultant will be leading the group. You understand that this is not therapy and is not a substitute for therapeutic treatment. You understand that the purpose of the support group is to be supported by others who want support for various life and/or mental health issues. You understand that information may be shared between group participants and the facilitator of the group. PeerVida will endeavor to protect confidentiality between support group participants and the group leader(s).

The fee for PeerVida Support Groups is $35 (US) per session.
The fee for other types of groups may vary.

The members and facilitators of this group are responsible for maintaining the confidence discussed within group sessions. As a member of this group, you agree to keep confidential all material discussed within group sessions as well as the identities of the group members.

As a PeerVida group participant, you agree to:

Be in a space free of distractions, where you am alone and can speak freely. Inform others at your location that they should not disturb you during this time. You further agree to not attend the group while in bed, but to treat the group meeting as you would a professional gathering.  Wear appropriate clothing commensurate with attending a group meeting in person. Failure to do so will cause immediate ejection from the group by the facilitator and will prevent you from attending future groups.

You agree to attend the group with both the audio and video components of your computer or phone turned on. It is permissible to mute the audio of your computer or phone if you are not speaking, however, it is not permissible for you to attend a group with your camera turned off or with a picture or avatar of yourself in place of an actual video of me.

If attending while in your car, you must not be driving or in transit. The group facilitator reserves the right to eject you from the group without warning if it appears that you are driving, or your vehicle is moving

You acknowledge that you have the technological means to attend the group. This includes being on a secure internet connection, rather than public or free Wi-Fi; keeping the video steady and at eye level so that your face is visible. Whenever possible, keep the volume low to prevent sound from traveling to another room. If you are having Internet issues or Wi-Fi issues on your end during your group time, you will not receive a refund if you cannot attend the entire group.  It is your responsibility to have an adequate connection to the internet.

Follow any group-established policy regarding if a member, or the entire group, gets disconnected. If the group agrees, this may include having a member call in for the remainder of the session.

You agree to adhere to the group policy regarding confidentiality. You will ensure that no nonmember bystanders can witness the group; this also includes someone walking into a room while the group is meeting. Additionally, You agree to not disclose to others outside of the group, anyone who is in attendance in the groups, what they have said, or any other identifying, confidential information. Failure to comply with these rules will result in immediate expulsion from the group as well as being barred from attending other groups in the future.

You understand that the group facilitators will make every effort to maintain confidentiality within the support group; however, there are limits to confidentiality. Specifically, confidentiality is contingent upon the entire group’s participation; furthermore, the group leader(s) may be ethically and legally bound to break confidentiality if
1) A group member is a danger to self, others, a location or entity,
2) there is a strong suspicion of child, elder, or a disabled person abuse where a person is currently at risk,
3) the group facilitators are mandated to disclose information by court order,
4) There is an intent to carry out an action against a public place and/or a group of people.

Additionally, there may be instances in which the group leader(s) will discuss with PeerVida qualified personnel details of the group for training and supervision purposes. You understand that you may speak to the facilitators about these limits at any time to obtain further clarification.