1. Purpose and Nature of Telehealth Services

You, the patient, understand that telehealth services involve the use of electronic communications to consult with, diagnose, and/or treat health conditions remotely. Telehealth may include videoconferencing, audio communication, and/or digital transmission of medical data.

2. Patient Acknowledgements and Responsibilities

By signing this consent, you affirm and agree to the following: • Legal Capacity: You confirm that you are 18 years of age or older and have the legal capacity to provide informed consent for telehealth services. If you are under 18, a legally authorized parent or guardian must complete this form on your behalf. • Voluntary Participation: You are voluntarily choosing to participate in telehealth services. You may refuse or discontinue services at any time without affecting your right to future care or treatment. • Assumption of Risk: You acknowledge and accept all risks associated with telehealth, including but not limited to: o Interruptions, technical difficulties, and unauthorized access to communication. o Limitations in diagnosis due to the absence of physical examination. o Delays in treatment due to system or communication failure. • Accuracy of Information: You agree to provide complete and accurate health information and understand that the provider relies on the accuracy of your statements. • Technology Requirements: You are solely responsible for securing the technology and internet connection used for telehealth sessions. You understand that poor connectivity or technical failure on your part may compromise care and is not the responsibility of the provider. • Environment for Care: You agree to ensure your environment is private, safe, and free from distractions during the session. The provider is not liable for confidentiality breaches caused by your chosen location.