Telehealth Consent

Part of my screening, follow-up, or consultation with Emet Drip Co may take place by phone or video (“telehealth”) rather than in person. By signing below, I acknowledge and agree that:

• Telehealth allows my provider to gather health history, screen for treatment eligibility, and follow up with me remotely by phone or video.
• The same privacy and confidentiality protections that apply to in-person care apply to my telehealth encounter.
• Telehealth has limitations. My provider cannot perform a physical exam and relies on the health information I report. If in-person evaluation is needed, I will be advised.
• I may request an in-person visit instead of telehealth at any time, and I may withdraw this consent at any time without affecting my future care.
• Telehealth is not for emergencies. If I experience a medical emergency, I will call 911 or go to the nearest emergency department rather than contacting Emet Drip Co.