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Telehealth Information & Consent

This consent outlines the risks, benefits, limitations, privacy protections, emergency procedures, and expectations associated with receiving psychiatric services through telehealth. 

Telehealth Consent

Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a patient and a healthcare provider who are not in the same physical location. Examples include live video conferencing, audio communications, and secure electronic messaging.

By agreeing below, I voluntarily consent to participate in telehealth services provided by Horizons Mental Wellness LLC and its authorized clinicians. I understand and agree to the following:

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Nature of Telehealth Services

  • Telehealth allows my provider to evaluate, diagnose, and treat me using secure electronic technologies.

  • Services are provided through a HIPAA-compliant electronic health record (EHR) platform that may include technology-assisted tools designed to enhance documentation accuracy, quality, and efficiency.

  • All electronic systems used by this practice, including those supporting documentation and communication, meet HIPAA security standards, and all data remain subject to HIPAA protections.

 

Confidentiality and Privacy

  • My privacy and confidentiality are protected under the same federal and state laws that apply to in-person healthcare.

  • The electronic transmission of information will be encrypted and securely stored.

  • Although reasonable measures are taken to ensure confidentiality, I understand that security risks may exist with any electronic communication.

 

Patient Responsibilities

  • I agree to participate in telehealth sessions from a private, distraction-free, and safe location within a state where my provider is licensed to practice.

  • I will not participate in a telehealth session while driving or engaging in activities that could compromise safety or privacy.

  • I will provide accurate contact information and notify the provider if my location changes during a session.

 

Emergencies and Limitations

  • I understand that telehealth may not be appropriate for all conditions or crises.

  • In the event of an emergency, I agree to call 911 or go to the nearest emergency department.

  • If my provider loses connection during a session, I will attempt to reconnect and/or follow the backup communication plan discussed during my visit.

 

Electronic Communication & Telehealth Acknowledgment

  • I understand that Horizons Mental Wellness LLC provides services and communication via secure HIPAA-compliant telehealth platforms (Tebra and Spruce). Messaging is not continuously monitored and is not for emergencies.

 

Consent and Withdrawal

  • I understand that I may withdraw consent for telehealth services at any time by providing written notice, except to the extent that actions have already been taken based on this consent.

  • I acknowledge that my provider may determine telehealth is no longer appropriate for my care and recommend in-person or alternative services.

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