Setting up an online therapy practice sounds straightforward — get a camera, pick a platform, start seeing clients. In practice, there are about fifteen decisions to make before your first session, and the ones you skip tend to create problems six months later.

This guide covers everything you actually need: platforms, scheduling, intake, documentation, security, and the physical setup of your workspace. With specific recommendations, not just principles.

First decision: fully online, hybrid, or transitioning?

Before anything else, be clear on your model:

Fully online — all clients seen via video. Simpler to set up, no overhead for a physical space, geographic flexibility. You’ll need a robust home office setup and clear protocols for everything that happens in person in a traditional practice (crisis situations, paperwork signing, etc.).

Hybrid — some clients in person, some online. Common for established practitioners adding online capacity. Requires maintaining two parallel systems — don’t let them bleed into each other.

Transitioning existing clients online — existing clients you’re moving from in-person to video. Requires explicit informed consent for the format change and a conversation about what’s different.

Your model determines which decisions matter most. A fully online practice needs to solve everything from scratch; a hybrid practice needs good system separation.

Video platform: the most consequential choice

Your video platform is the infrastructure everything else runs on. Get this right first.

What actually matters

End-to-end encryption. The gold standard: content is encrypted so even the platform provider can’t access it. Some platforms encrypt in transit but store unencrypted on their servers — meaningfully different.

Business Associate Agreement (BAA). If you’re a HIPAA-covered provider in the US, you need a BAA with your video platform. Most consumer-grade services (including standard Zoom and Google Meet) don’t offer this on free plans.

No automatic recording or data use. Read the terms of service. Some free platforms reserve rights to use your data for algorithm training. That’s incompatible with clinical use.

Waiting room functionality. Clients shouldn’t be able to join before you’re ready. A waiting room gives you control.

Video platform options

✅ Doxy.me (free tier) — a solid starting point. Built for telehealth, HIPAA BAA at no cost, waiting room included, no software download required for clients. Use this for video calls.

⚠️ Zoom for Healthcare — HIPAA BAA available, but expensive ($200+/mo) and requires deliberate configuration. Not built for therapy.

⚠️ Google Meet (Workspace for Healthcare) — BAA available on paid plans, but transit encryption only. Needs configuration. Not purpose-built for clinical use.

❌ Standard Zoom / Google Meet / WhatsApp / FaceTime — no BAA, no clinical-grade encryption. Not appropriate, regardless of how convenient they feel.

The bigger picture: video is only one piece

Choosing a video platform solves one problem: the call itself. But an online practice needs more than a working video link.

After every session, you still need to:

  • Write and store session notes securely
  • Maintain a complete client record (intake, anamnesis, history)
  • Track homework, agreements, and follow-ups
  • Prepare for the next session in under 2 minutes

This is where most therapists underinvest. They spend time picking the right video platform and then store session notes in a personal Google Doc, a random notebook, or nowhere at all.

The practical setup that works: use Doxy.me (free) for video calls, and TheraMemory for everything that surrounds the session — client cards, structured session notes, full history in one secure place. You get a clinical-grade documentation system without paying for an all-in-one platform you don’t fully need yet.

Scheduling

You need a system that:

  • Lets clients book (or request) appointments without email back-and-forth
  • Sends automated reminders (reduces no-shows significantly)
  • Keeps your professional calendar separate from your personal one
  • Handles timezone display correctly if you see clients in multiple timezones

Options:

  • Calendly — simple, works, free tier is functional. Clients see your availability and book. Downside: not purpose-built for therapy, no clinical features.
  • Acuity Scheduling — more customizable, intake form integration, offers a BAA for HIPAA compliance.
  • Jane App / SimplePractice / Therapy Notes — purpose-built practice management platforms that include scheduling as part of a broader system.

The mistake to avoid: Using your personal Google Calendar for client scheduling. No reminders, no client-facing booking, and your clinical schedule mixed with your personal life.

Client intake: what to send before session one

Before you see a new client online, they need to receive and sign:

Standard informed consent adapted for online work. Must explicitly cover:

  • The nature of online therapy and its differences from in-person
  • Confidentiality limits specific to digital communication
  • What happens if the connection drops mid-session
  • Emergency procedures (what to do if they’re in crisis and can’t reach you)
  • Your cancellation and no-show policy

Practical tip: Don’t send a 12-page document. Clients won’t read it. One to two pages, plain language, with a signature line. Longer documents can live separately as supplementary materials.

2. Technology agreement

A short document (or section of consent) covering:

  • Client responsibility to be in a private location during sessions
  • Not recording sessions without explicit permission
  • Using a secure network (not public Wi-Fi)
  • What platform you’ll use and a link to test it before session one

3. Emergency contact and safety plan

In online work you can’t physically intervene if a client is in crisis. Before session one, collect:

  • Emergency contact name and number
  • Client’s current address (for emergency services if needed)
  • Agreement on what the client will do if they’re in crisis between sessions

For high-risk clients: Have this conversation explicitly and document it, don’t just collect it on a form.

4. Credit card or payment method on file

Sort out payment before the first session, not after. Awkward conversations about money are easier before the therapeutic relationship is established.

Your physical setup: what clients see and hear

This matters more than therapists usually think. A poor setup creates distraction and erodes the sense of professionalism.

Camera and lighting

  • Camera position: Eye level, not looking up at you from a desk. A stack of books works if you don’t have a monitor arm.
  • Distance: Close enough that your face fills most of the frame. Too far away feels cold; too close is uncomfortable.
  • Lighting: Light source in front of you, not behind. A window behind you = you’re a silhouette. A ring light or desk lamp facing you = professional, even look.
  • Background: Neutral, uncluttered. A bookshelf is fine; a messy kitchen is not. Virtual backgrounds work but can look cheap — test yours before relying on it.

Audio

Bad audio is worse than bad video. Clients can tolerate a slightly fuzzy image; they cannot tolerate echoing, tinny sound, or background noise.

  • Use a headset or external microphone rather than laptop speakers + built-in mic (which picks up fan noise and causes echo)
  • A simple USB headset (£20–30) makes an immediate difference
  • Close the door, use a rug or soft furnishings to reduce echo in the room

Connection

  • Wired connection is better than Wi-Fi for video calls — more stable, lower latency
  • Minimum: 10 Mbps upload speed. Check yours at fast.com before relying on it
  • Have a backup plan: if your internet drops, can you switch to mobile data hotspot? Tell clients what to do if the call drops (the standard practice: you call them back within 3 minutes)

Privacy

  • Close the door. Put a “session in progress” sign on it if others are in the building
  • Use headphones so the client’s voice isn’t audible outside the room
  • Consider a white noise machine outside the door if sound carries

Documentation in an online practice

Your documentation needs are the same as in-person practice — you still need session notes, intake records, and a treatment plan. But a few things are specific to online work:

Note the modality. Each session note should indicate it was conducted via telehealth. This matters for insurance billing and for your clinical record.

Record technical events. If the connection dropped for several minutes, the client was late due to tech issues, or you had to switch platforms mid-session — note it.

Your observational data is more limited. You’re seeing the client from the shoulders up. You miss posture, fidgeting, the way they walk in, body language below the frame. Your Objective section should reflect what you can actually see — don’t overextend.

Where to keep notes: The same security considerations apply as anywhere else in practice — client data needs to be stored somewhere with appropriate access controls and encryption. Google Docs and personal cloud storage aren’t appropriate for clinical notes. Purpose-built practice management tools or encrypted local storage are.

Security checklist: the non-negotiables

Before seeing your first online client, confirm:

  • Video platform has signed BAA (if HIPAA applies to you)
  • Your device has a screen lock and disk encryption enabled
  • You’re on a private, password-protected network (not public Wi-Fi)
  • Client notes are stored in an appropriately secure system
  • Automatic recording is turned off on your video platform
  • You have a clear policy on client communication channels — email, messaging, etc.

Emergency protocol: write this down before you need it

The most common gap in online practice setups. If a client is in crisis during a session:

  1. Assess immediately — ask directly: “Are you safe right now?”
  2. If they say no or you’re concerned: ask where they are (street address)
  3. Stay on the call; have them call emergency services or call yourself
  4. If the connection drops during a crisis: call them back immediately on the phone number you have on file
  5. If you can’t reach them: contact their emergency contact; consider contacting emergency services at their address

Write this protocol out. Know it before you need it. Have phone numbers accessible — not buried in email.

Common mistakes when setting up online

Using a free consumer platform without a BAA. Standard Zoom, Google Meet, FaceTime — these are not appropriate for clinical use without enterprise agreements and proper setup. The fact that everyone uses them doesn’t make them compliant.

Skipping the technology agreement. Clients joining from coffee shops, recording sessions on their phone, having family members in the background — these aren’t hypothetical. A one-paragraph technology agreement prevents most of it.

No backup communication method. What’s your phone number? Does the client have it? What do they do if the video drops? Answer these questions before the first session.

Inconsistent note-taking. Online practice creates an illusion that things are easier to track — you have the video call on your computer, your notes could be right there. In practice, therapists often end up with notes in random places. Build your notes system before client one.

Treating telehealth as “just a phone call with video.” Online therapy has genuine clinical differences: you can’t observe the full body, the transition into and out of the session is different, the therapeutic frame is different (client is in their own space, with their own objects and context around them). Think about how this affects your clinical work, not just your logistics.

First week checklist: getting started

Before seeing any clients:

  • Video platform chosen and tested from your setup
  • BAA signed with platform (if needed)
  • Informed consent document written and reviewed
  • Technology agreement ready
  • Emergency protocol written and accessible
  • Notes system decided and set up
  • Scheduling tool live and tested
  • Payment collection in place

After your first session:

  • Write your session note immediately — don’t wait
  • Review what felt awkward technically and fix it
  • Note what’s different clinically from in-person work with this client

After your first month:

  • Review your no-show rate — are reminders working?
  • Check your notes system — are you actually using it consistently?
  • Ask: is there anything I’m still doing manually that should be automated?

Online therapy practice is genuinely more flexible than office-based work — but it’s not simpler. The flexibility comes at the cost of having to consciously build everything that an office building used to provide: the waiting room, the soundproofing, the paper files, the reception function. Get the infrastructure right first. Everything else is easier once it’s in place.

Try TheraMemory free for 14 days

TheraMemory gives you client records, session notes, and intake documentation in one secure place — built for private practice therapists working online or in person.

The documentation system you need from day one, without building it yourself.

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