Telehealth Appointment

Description

20-minute telehealth appointment

No insurance accepted

TELEHEALTH INFORMED CONSENT

I understand that telehealth involves the communication of my medical/mental health information in an electronic or technology-assisted format.

I understand that Telehealth services can only be provided to patients, including myself, who are residing in the state of Texas, Washington & New Mexico at the time of this service.

I agree that information exchanged during my telehealth visit will be maintained by the healthcare provider involved in my care.

I understand that medical information, including medical records, are governed by federal and state laws that apply to telehealth.

I understand that electronic communication cannot be used for emergencies or time-sensitive matters.

I understand and agree that a medical evaluation via telehealth may limit my healthcare provider’s ability to fully diagnose a condition or disease. As the patient, I agree to accept responsibility for following my healthcare provider’s recommendations—including further diagnostic testing, such as lab testing or an in-office visit.

I certify that I have read and understand this agreement by agreeing to the terms