Behavioral Health Treatment Agreement

Before or during your first session, your provider will work with you to establish a personalized safety plan. You will be asked to provide:

• An emergency contact who can be reached if you are at risk
• Your current physical location at the start of each session
• The name and address of your nearest emergency department

If your provider determines you are at immediate risk of harm, they may contact your emergency contact, local emergency services, or initiate referral to a higher level of care in accordance with the Kenya Mental Health Act.

MDZuri behavioral health providers offer treatment for:

• Depression and mood disorders
• Anxiety disorders (generalized, social, panic, phobias)
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Bipolar disorder (stabilized, with medication management)
• Grief, loss, and adjustment difficulties
• Relationship and family issues
• Stress management and burnout
• Sleep disorders (non-medical)

The following conditions are outside the scope of MDZuri telehealth behavioral health services and require in-person or specialized care:

• Active psychosis or severe thought disorder
• Substance use disorder requiring medical detoxification
• Severe eating disorders requiring medical monitoring
• Conditions requiring inpatient psychiatric care
• Court-ordered evaluations or forensic assessments
• Conditions requiring physical examination

If your provider determines that your condition is outside the scope of telehealth, they will refer you to appropriate in-person services.

Everything you share with your provider is confidential. However, there are situations where your provider is legally required or ethically obligated to disclose information without your consent:

• Imminent danger to yourself — if you are at immediate risk of self-harm or suicide
• Imminent danger to others — if you make a credible threat to harm an identifiable person (duty to warn)
• Suspected child abuse or neglect — as required by the Kenya Children Act
• Suspected abuse of elderly or vulnerable persons
• Court order — if compelled by a court of law
• Public interest or preventing serious harm — as permitted by the Kenya Mental Health Act, Section 3H

Your provider will make every effort to discuss any disclosure with you before it occurs, unless doing so would compromise safety.

Behavioral health therapy and psychiatry sessions are NOT recorded. This protects the sensitive and private nature of mental health treatment. If MDZuri offers asynchronous messaging as part of your care, text messages between you and your provider are part of your medical record and are retained securely.

If you are receiving psychiatric medication management through MDZuri:

• Your provider will prescribe medications based on their clinical assessment
• Certain controlled substances may not be prescribed via telehealth in accordance with Kenyan Pharmacy and Poisons Board regulations
• You must disclose all current medications, supplements, and substances to your provider
• Lab work may be required before or during treatment — you are responsible for completing this at a local facility
• Medication refills require regular follow-up appointments as determined by your provider
• Prescriptions are not guaranteed for any consultation

All communication with your provider must go through the MDZuri platform. Do not contact your provider through personal phone numbers, email addresses, or social media accounts.

• Messages sent through the platform are not intended for emergencies
• Providers will respond to non-urgent messages within 48 hours on business days
• Clinical discussions that require a full assessment should be addressed in a scheduled session, not via messaging

For patients under 18 years of age:

• A parent or legal guardian must provide written consent before treatment begins, as required by the Kenya Mental Health Act
• The minor is the client — the therapeutic relationship is between the provider and the minor
• To build trust and facilitate effective treatment, providers may keep certain session content confidential from parents, except where safety is a concern
• Parents will be informed if there is a risk of harm to the minor or others
• Guardianship documentation may be required (parenting plans, custody orders)

Under the Kenya Mental Health Act (Section 3I), you may appoint a supporter — a trusted person who can assist you in making decisions about your mental health care. Your supporter must follow your will and preferences. You may appoint or change your supporter at any time by notifying your provider.

Your treatment may be ended under the following circumstances:

• By you: You may discontinue treatment at any time. We encourage you to discuss this with your provider to ensure appropriate planning
• By your provider: If you repeatedly miss appointments (two consecutive no-shows, or three within 3 months), your provider may terminate care with a referral to alternative services
• For safety: Threatening, abusive, or inappropriate conduct toward staff or providers will result in immediate termination
• Clinical appropriateness: If your provider determines telehealth is no longer suitable for your needs, they will refer you to in-person care

In all cases, your provider will make reasonable efforts to provide continuity of care, including referrals to other providers or services.

Therapy and psychiatry sessions require advance scheduling. Please cancel or reschedule at least 24 hours before your appointment. Late cancellations and no-shows may result in:

• Forfeiture of the session fee (no refund)
• Repeated no-shows may lead to treatment termination (see Section 11)

If you arrive late, your provider will wait up to 10 minutes for therapy sessions and 5 minutes for psychiatry sessions before the session is marked as a no-show.

You have the right to request a different provider if you feel your current provider is not the right fit. Continuity of care is important in behavioral health — frequent provider changes may impact treatment outcomes. Your provider may discuss referral options with you if they believe another provider would better serve your needs.

MDZuri behavioral health providers do not provide forensic or legal services, including but not limited to:

• Custody evaluations or recommendations
• Court testimony or expert witness services
• Disability determinations
• Emotional support animal or service animal certifications

If legal proceedings arise that involve your treatment, please inform your provider immediately.

• Attend scheduled sessions on time and in a private, quiet location
• Actively engage in your treatment plan and follow recommendations
• Provide your physical location at the start of each session (for safety purposes)
• Disclose all medications, substances, and relevant medical conditions
• Complete any required lab work within the timeframes specified by your provider
• Inform your provider of any changes in your condition or circumstances
• Do not attend sessions while under the influence of drugs or alcohol

By checking the behavioral health treatment agreement box during your mental health appointment booking, you acknowledge that you have read and understood this agreement. You consent to behavioral health treatment through the MDZuri platform under the terms described above. This agreement supplements, and does not replace, the general Informed Consent for Telehealth Services.