Telehealth Informed Consent

You are going to have a clinical encounter using phone or videoconferencing technology. You will be able to see and/or hear the provider and they will be able to see and/or hear you, just as if you were in the same room. The information may be used for diagnosis, treatment, therapy, follow-up and/or education.

  • Improved access to care by enabling a client to remain at a remote location and obtain services from providers at distant sites.
  • Client remains closer to home where local healthcare providers can maintain continuity of care.
  • Reduced need to travel for the client or other provider.

If you are not comfortable with seeing a provider on videoconference technology, you may schedule a traditional telephone session without video at any time. Safety measures are being used to ensure that this videoconference is secure, and no part of the encounter will be recorded without your consent.

There are potential risks associated with the use of telehealth which include, but may not be limited to:

  • A provider may determine that the telehealth encounter does not provide sufficient information to make an appropriate clinical decision, which may require additional in-person visits.
  • Technology problems may delay medical evaluation and treatment at any time.
  • In very rare instances, security protocols could fail, causing a breach of privacy of your information. You will be promptly notified if any security issues arise.
Last Updated 6/23/23