Telehealth Informed Consent

Nature of telehealth care

Your provider will review the information you submit, may request labs or additional detail, and will decide whether treatment is appropriate. No physical examination is performed unless your provider arranges one locally.

Benefits

• Access to licensed providers without travel or waiting rooms.
• Faster follow-up and messaging between visits.
• Coordinated pharmacy fulfillment when medication is prescribed.

Limitations and risks

• Without an in-person exam, a condition could be missed or a diagnosis delayed; incomplete or inaccurate information increases that risk.
• Technology failures may delay communication or care.
• Despite security safeguards, no electronic transmission can be guaranteed fully private.
• Some conditions cannot be treated by telehealth and require in-person evaluation.

Medication and compounded formulations

If your provider prescribes a compounded medication, you understand that compounded medications are not FDA-approved and have not been evaluated by the FDA for safety, effectiveness, or quality. Your provider will discuss expected effects and possible side effects with you.

Emergencies

Telehealth is not for emergencies. If you have chest pain, difficulty breathing, severe abdominal pain, a severe allergic reaction, or thoughts of self-harm, call 911 or go to the nearest emergency department.

Records, alternatives, and withdrawal

• Your telehealth encounter is documented in your medical record.
• You may seek in-person care at any time instead of, or in addition to, telehealth.
• You may withdraw this consent in writing at any time without affecting your right to future care.

Acknowledgment

By submitting an intake, you confirm you have read this consent, had the opportunity to ask questions, and agree to receive care by telehealth.