Last Updated: December 2024
I understand that Telehealth is a mode of delivering health care services via communication technologies (e.g., internet or cellphone) to facilitate diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care.
By acknowledging my consent below, I understand and agree to the following:
- I understand that AmberHealth offers Telehealth consultations, which are conducted through videoconferencing, telephonic, and asynchronous technology and my Telehealth provider will not be present in the room with me.
- I understand there are potential risks to the use of Telehealth technology, including but not limited to, interruptions, delays, unauthorized access, and/or other technical difficulties. I understand that either my Telehealth provider or I can discontinue the Telehealth appointment if the technical connections are not adequate for my visit.
- I understand that I could seek an in-office visit rather than obtain care from a Telehealth provider, and I am choosing to participate in a Telehealth consultation with an AmberHealth provider.
- To protect the confidentiality of my health information, I agree to undertake my Telehealth consultation in a private location, and I understand that my Telehealth provider will similarly be in a private location.
- In an emergent situation, I understand that the responsibility of my Telehealth provider may be to direct me to emergency medical services, such as an emergency room.
By acknowledging below, I certify:
- That I have read this form and/or had it explained to me
- That I understand the risks and benefits of a Telehealth appointment
- That I have been given the opportunity to ask questions and that such questions have been answered to my satisfaction
Consent to Text or Email Usage
Last Updated: December 2024