Telehealth Holisitic Therapy Consent

Holistic Session; is defined as Chiropractic/Nutrition/Physical therapy rendered via phone or video conference by a licensed Virginia Healthcare Professional.

Telehealth Holistic Session/Therapy: Telehealth technology allows healthcare providers to examine the patient with interactive videoconferences. Healthcare professionals, physicians, and therapists can remotely provide necessary services with this technology.

Purpose: The purpose of the Telehealth Holistic Session Consent Form is to obtain the patient's consent to participate in telehealth Holistic consultation services.

Confidentiality: Therapists and professionals conduct the therapy with videoconference or phone conference and any voice and video from the patient will not be recorded. The health condition and history of the patient will be kept confidential and can be used for future research on their case.

Patient Rights: The patient can withhold or withdraw the telehealth therapy consent at any time and this will not affect future treatment. The patient can ask questions regarding the consent, telehealth services and procedures for clarification.

Risks & Benefits: The patient has been informed about the potential risks and benefits of the telehealth service. He/she has understood that he/she can make a complaint about the telehealth services by online channels or calling the complaint line, 434-481-2012.

Services: Professionals, physicians, and therapists will schedule and conduct the treatment process. Patients accept these terms and to pay a Tele or Phone Holistic Therapy session fee: $45 first 10 minutes, $40 per 10 minute block after that.