Permission for Telehealth Visits

What is telehealth?
Telehealth is a way to visit with healthcare providers, such as your doctor or nurse practitioner.
You can talk to your provider from any place, including your home. You don’t go to a clinic or hospital.

How do I use telehealth?
•    You talk to your provider by phone, computer, or tablet.
•    Sometimes, you use video so you and your provider can see each other.

How does telehealth help me?
•    You don’t have to go to a clinic or hospital to see your provider.
•    You won’t risk getting sick from other people.

Can telehealth be bad for me?
•    You and your provider won’t be in the same room, so it may feel different than an office visit.
•    Your provider may make a mistake because they cannot examine you as closely as at an office

      visit. (We don’t know if mistakes are more common with telehealth visits.)
•    Your provider may decide you still need an office visit.
•    Technical problems may interrupt or stop your visit before you are done.

Will my telehealth visit be private?
•    We will not record visits with your provider.
•    If people are close to you, they may hear something you did not want them to know. You should

      be in a private place, so other people cannot hear you.
•    Your provider will tell you if someone else from their office can hear or see you.
•    We use telehealth technology that is designed to protect your privacy.
•    If you use the Internet for telehealth, use a network that is private and secure.

What if I want an office visit, not a telehealth visit?
For now, all visits are by telehealth. You cannot schedule an office visit now. You must wait until the office opens for all other appointments. We do not know when that will be.

What if I try telehealth and don’t like it?
•    You can stop using telehealth any time, even during a telehealth visit.
•    You can still get an office visit, but only when our offices reopen.
•    If you decide you do not want to use telehealth again, let us know by phone, text or email.

How much does a telehealth visit cost? 
•    What you pay depends on your insurance.
•    A telehealth visit will not cost any more than an office visit.

Do I have to sign this document?
No. Only sign this document if you want to use telehealth.
If you have questions, do not sign this form until you have discussed it with your provider.

What does it mean if I sign this document?
If you sign this document, you agree that:
•    You understand the information in this document.
•    We answered all any questions you may have had.
•    You want telehealth visits.

Center for Counseling, Healing & Growth