Telehealth Consent

Telehealth, (also called Telemedicine), is a way to visit with your healthcare provider without going to the hospital or clinic. The visits are held by computer, tablet or telephone. This form gives permission for telehealth communication between NeoSleep, LLC and the patient.

I understand that telehealth involves sharing my medical/mental health information electronically. I will tell my healthcare provider if there is any information that I do not want to talk about in a telehealth visit.

I understand that I may stop the telehealth visit at any time. If I decide to stop, I will still be able to have medical care at this office.

I understand that I may have to check with my health insurance plan to see if telehealth visits are covered.

I understand that telehealth visits carry some level of risk. These risks include but are not limited to:

My computer, tablet or phone may not be private and secure, especially if other people use it. It is my responsibility to make sure my internet system is private and secure and to make sure that I am in a private place during the visit.

Technical problems may interrupt or stop the visit before it is done.

My healthcare provider cannot examine me as closely during a telehealth visit, and this may make it harder to determine what is wrong with me.

I agree that information shared during my telehealth visit will be kept by the healthcare providers and facilities involved in my care.

I understand that telehealth visit will not be recorded.

I agree to follow my healthcare provider's recommendations, including lab tests and studies, sending me to a specialist, or asking me to come to the office or go to an emergency department for an in-person visit.