Consent to Telehealth

Last updated: April 20, 2025

This Consent to Telehealth (“Consent”) applies to all mental health and related medical services provided to you by Adler Health (“we,” “us,” or “our”) through electronic communication technologies, including but not limited to video conferencing, secure messaging, electronic prescribing, and mobile platforms (“Telehealth Services”).

By clicking “I Agree,” signing electronically, or otherwise indicating acceptance, you acknowledge and agree to the following:

1. Nature of Telehealth

Telehealth involves the delivery of mental health and medical services using interactive audio, video, or other electronic media. During your telehealth consultation:

  • You will communicate with a licensed mental health professional or medical provider.
  • Medical history, symptoms, and relevant data may be discussed digitally.
  • You may receive diagnoses, treatment plans, or prescriptions electronically.
  • Your information will be securely documented and stored.

2. Scope of Services

By consenting, you authorize Adler Health to provide the following via telehealth:

  • Mental health evaluation, consultation, diagnosis, and treatment.
  • Remote psychotherapy or counseling sessions.
  • Prescription of medication when clinically appropriate and legal.
  • Home delivery of medication, if approved by the provider.

3. Risks and Limitations

Telehealth offers convenience but also comes with limitations, including:

  • Technical interruptions or security vulnerabilities.
  • Lack of physical examination may limit assessment.
  • Referral for in-person care may be required in some cases.

You accept these risks and confirm telehealth is appropriate for your needs.

4. Privacy and Confidentiality

We follow HIPAA and use secure, encrypted platforms:

  • Telehealth communications are confidential.
  • Records are securely stored and accessed only by authorized personnel.
  • You may request copies of your medical records at any time.

Despite safeguards, digital communication involves some risk of unauthorized access.

5. Your Responsibilities

By using our services, you agree to:

  • Provide accurate and complete health information.
  • Disclose symptoms and medical history truthfully.
  • Be located in a U.S. state where we operate legally.
  • Participate from a private, secure environment.
  • Follow clinical instructions and treatment plans.

6. Payment and Insurance

You agree to pay all applicable fees. Insurance coverage for telehealth varies. You are responsible for verifying benefits with your insurer.

7. Emergency Situations

Telehealth is not for emergencies.

If you are in crisis, call 911 or go to the nearest emergency room. For suicidal thoughts, call 1-800-273-TALK (8255).

8. Right to Withdraw Consent

You may withdraw consent at any time by written notice. Your decision does not affect your right to future care, but some services may require in-person visits if telehealth is declined.

9. Consent and Acknowledgment

By accepting this agreement, you confirm that:

  • You have read and understood this Consent to Telehealth.
  • Your questions about telehealth have been answered.
  • You are legally authorized to consent to care for yourself or a dependent.
  • You agree to receive telehealth services from Adler Health.

If you agree to the above, please click “I Agree” or otherwise indicate acceptance as required by Adler Health’s platform.