Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share individual patient information to improve patient care. Services may include psychiatric evaluations, medication management, psychotherapy, follow-up care, and patient education.

I understand that:

• Telehealth services are provided remotely via HIPAA-compliant video or audio platforms.
• The scope of care will be consistent with in-person services, though some limitations may exist.
• All laws governing confidentiality, privacy, and patient rights apply to telehealth services.

Benefits may include improved access to care, convenience, and continuity of treatment. Potential risks include, but are not limited to:

• Interruption or technical failure of electronic equipment.
• Information security concerns or accidental data breaches.
• Limited ability to respond to crises or perform physical exams.

I acknowledge that I may decline or discontinue telehealth services at any time without affecting my right to future in-person care, if available.

• All communications via telehealth are conducted using encrypted, HIPAA-compliant platforms.
• Nevertheless Psychiatric Services LLC will not record telehealth sessions without written consent.
• I agree not to record any part of the session without the provider’s explicit permission.
• I understand that confidentiality will be maintained unless a legal or safety exception applies (e.g., risk of harm to self or others, mandated reporting of abuse, court order).

Telehealth services are not appropriate for emergencies or crises. If I experience a crisis or emergency, I agree to:

• Call 911 or go to the nearest emergency room.
• Contact the National Suicide & Crisis Lifeline on 988 if needed.

I agree to provide my current physical location and emergency contact at the start of each telehealth session in case immediate intervention is required.

I understand I must:

• Be in an eligible State at the time of the session.
• Have a secure, private space and a reliable internet connection.
• Inform my provider of any changes to my medical or mental health condition.
• Comply with treatment recommendations and attend scheduled appointments.

By signing below, I acknowledge that I:

• Have read and understood the information provided in this form.
• Have had the opportunity to ask questions.
• Consent to receive psychiatric services via telehealth through Nevertheless Psychiatric Services, LLC.
• Understand I can withdraw my consent at any time by notifying my provider in writing.