Natural Terrain Therapy

Telehealth Consent Form

PURPOSE: The purpose of "Telehealth Consent Form" is to get the client's consent in order to participate in appointments of telehealth cares.
RECORDS: Telecommunications with clients will not be recorded and stored. Client's medical information obtained by the diagnosis and analysis can be used anonymously for further improvements in scientific studies.

TELEHEALTH INFORMATION: The medical information related to history, records and tests of the client's will be discussed during the telehealth appointment with video and audio.
ACCESS: The client accepts that he/she needs access to PC, laptop, or mobile device and a good internet connection in order to have an efficient telehealth appointment.
CLIENT RIGHTS: The client can withdraw his/her consent at any time and can ask the questions related to telemedicine appointments and technical requirements for telecommunication.

Form

By signing this form,

I understand that all the laws that are protecting my privacy of health history or information are also applied to telehealth practices.

I understand that I can withdraw the consent at any time and that will not affect any of my future sessions.

I understand that I can be charged the additional fees that my insurance does not cover.

I accept that I authorize health care professionals to use telehealth for my treatment and diagnosis.

I agree to terms & conditions.