• Telepractice Consent & Financial Agreement

  • Services are provided in accordance with regulatory standards of CHCPBC (BC), ACSLPA (Alberta), and SASLPA (Saskatchewan).

    Telepractice involves delivery of speech-language pathology services using secure videoconferencing technology.

     
    Potential risks include:

    • Technical disruption

    • Reduced ability for hands-on examination

    • Privacy limitations inherent in electronic communication

     
    Services comply with BC PIPA, Alberta HIA/PIPA, and Saskatchewan HIPA.

    Telepractice is not emergency care. In case of emergency, call 911.

     

     
    Professional Fee:

    $150 per hour (prorated to actual time)

     

    Payment:

    Payment is due after each visit via e-transfer to empowerspeechsolutions@gmail. com. Receipts will be issued for insurance submission.

     

    Cancellation Policy:

    A minimum of 24 hours notice is required. Late cancellations or missed appointments may be billed at the full session rate.

      
    By signing below, I acknowledge that:

    • I understand the risks and benefits of telepractice
    • I consent to receiving speech-language services via telepractice
    • I understand confidentiality limitations
    • I agree to the financial terms above
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