Telehealth Informed Consent

This consent explains what it means to receive care through telehealth. Please read it carefully before starting your online visit. By checking the consent box during intake, you acknowledge and agree to the following.

What telehealth is

Telehealth is the delivery of healthcare services using electronic communications, which may include asynchronous questionnaires, secure messaging, telephone, and video. Through this platform, independent licensed providers evaluate your health information remotely and, when clinically appropriate, may issue a prescription.

Expected benefits

• Access to medical evaluation and treatment without an in-person appointment.
• Convenient follow-up, monitoring, and communication with your care team.

Possible risks

• The provider cannot perform a physical examination, so information you provide must be accurate and complete; incomplete information can affect clinical judgment.
• Delays in evaluation or communication may occur due to technology failures.
• In rare cases, security protocols could fail, causing a breach of privacy of personal health information.
• Telehealth may not be appropriate for every condition; the provider may determine you need in-person care and decline to treat you through this platform.

Your rights

• You may withhold or withdraw this consent at any time without affecting your right to future care or treatment.
• You may ask questions about your evaluation and treatment options, including their risks and benefits, and receive answers from your provider.
• You have the right to know the identity and licensure of the provider evaluating your care.
• The laws that protect the confidentiality of your medical information apply to telehealth.

Your responsibilities

• Provide truthful, accurate, and complete health information, including all medications, allergies, and conditions.
• Verify your identity as required by law.
• Follow the treatment plan and safety information provided with any prescription, and report side effects or concerns to your provider promptly.
• Seek emergency care immediately by calling 911 for any medical emergency — telehealth is not for emergencies.

Alternatives

Alternatives to telehealth include in-person visits with a local provider. You are free to pursue in-person care at any time.

Acknowledgment

By checking the consent box during your online visit, you confirm that you have read and understood this Telehealth Informed Consent, that your questions have been answered to your satisfaction, and that you voluntarily consent to receive services via telehealth.