• Telehealth Informed Consent

  • Telehealth is healthcare provided by any means other than a face-to-face visit. In telehealth services, medical and mental health information is used for diagnosis, consultation, treatment, therapy, follow-up, and education. Health information is exchanged interactively from one site to another through electronic communications. Telephone consultation, videoconferencing, transmission of still images, e-health technologies, patient portals, and remote patient monitoring are all considered telehealth services.

  • Emergency Protocols

  • I need to know your location in case of an emergency.  You agree to inform me of the address where you are at the beginning of each session.  I also need a contact person who I may contact on your behalf in a life-threatening emergency only.  This person will only be contacted to go to your location for a well check or take you to the hospital in the event of an emergency.

  • I certify that I have read and understand this agreement and that all blanks were filled in prior to my signature with the opportunity to have questions answered to my satisfaction.

  • For electronic communications between * and staff an*

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