Telehealth Consultation Consent Form
A telehealth service is a dietetic and nutrition service, including consultation and treatment, delivered via video conferencing platforms or phone.
Please read the following statements carefully in order to provide your informed consent for undertaking telehealth consultations with your healthcare provider at Anthea’s Nutrition.
Telehealth Consultation Consent
1. I understand that my healthcare provider wishes me to engage in a telehealth consultation.
2. I understand that the laws that protect my privacy and the confidentiality of my medical information also apply to telehealth.
3. I understand that my healthcare provider has chosen a telehealth software platform which meets the recommended standards to protect the privacy and security of the consultation.
4. I understand that there are potential risks and consequences of participating in telehealth consultations, including interruptions, unauthorised access and technical difficulties.
5. I understand that my healthcare provider or I can discontinue the consultation if it is felt that the quality of the session is compromised due to issues such as interruptions and connection issues.
6. I understand that I have the right to withhold or withdraw my consent at any time, even during the telehealth consultation, without affecting my right to future care.
7. I understand that telehealth consultations will not be exactly the same as a direct visit due to the fact that I will not be in the same room as my healthcare provider.
8. I understand that my healthcare provider will NOT record our telehealth consultation. I also understand that I may have the ability to record the session from my end, in which case I will assume the responsibility of securing and protecting the recording.
9. I understand that I can ask my healthcare provider questions about the telehealth procedures prior to the consultation.
10. I understand that telehealth consultations do not provide emergency or medical services. If I am experiencing an emergency or medical complication, I understand that I can call 000 or seek medical advice.
11. Cancellation Policy- if in the case of cancelling my appointment, I understand that at least 24-hour’s notice needs to be given or the full fee will be charged, or for NDIS, this is subject to the conditions outlined in the service agreement.