Telehealth Attestation & Consent

By continuing, you acknowledge, attest, and agree to the following:

Regulatory Requirements
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Telehealth services are provided in accordance with applicable federal and state laws and regulations. These requirements may change at any time due to government action, including federal funding lapses, legislative changes, or regulatory updates.


Patient Circumstances

You attest that you are not reasonably able to access in-person care at this time due to one or more of the following: geographic distance, transportation barriers, mobility limitations, heightened risk of exposure to communicable illness, or lack of available local providers.


Consent to Telehealth

You consent to receive services via telehealth, including through a secure audio/video connection. You understand that telehealth may limit certain aspects of the physical examination, but that it is clinically appropriate and medically necessary for your care.


Risks and Benefits

You understand that telehealth involves potential benefits, including increased access, convenience, and continuity of care, as well as potential risks, including technical failures and limitations associated with a remote physical examination. Your provider will use professional judgment to determine the quality, safety, and appropriateness of your care.


Emergency Care

You understand that telehealth is not a substitute for emergency medical services. In the event of an emergency, call 911 or go to the nearest emergency department.You acknowledge that you have read and understood the foregoing, agree to its terms, and consent to receive behavioral health services via telehealth.