TELEHEALTH PATIENT CONSENT
PURPOSE: The purpose of this form is to obtain patient consent to participate in a telehealth session for behavioral and therapeutic services. Telehealth communications, including video and audio, will not be recorded. Notes will be taken by therapist to provide continuity of care.
MEDICAL INFORMATION: The information given by the patient for purposes of treatment will be discussed during the telemedicine appointment using video and audio.
ACCESS: The patient accepts that he/she needs access to a PC, laptop, or mobile device and a good internet connection in order to have an efficient telemedicine appointment.
PATIENT RIGHTS: The patient can withdraw his/her consent at any time. Any questions related to telemedicine appointments or technical requirements for telecommunication will be addressed throughout the full duration of treatment.