Patient Portal

Consent to Telehealth Treatment

Effective Date: 9/1/2025

By agreeing to this Consent, you acknowledge that you have read, understood, and agree to the following:

1. Nature of Telehealth

Telehealth involves the delivery of healthcare services using secure video, audio, and digital communication technologies. Your provider may:

  • Review your medical history and symptoms.
  • Conduct an examination through telecommunication tools.
  • Provide a diagnosis, treatment plan, or prescription when appropriate.

2. Benefits of Telehealth

  • Convenient access to care from your home or other location.
  • Reduced travel and wait times.
  • Access to licensed healthcare providers.

3. Possible Risks of Telehealth

  • Technology failures, including poor connection or interruptions.
  • Limitations in performing a physical examination.
  • In rare cases, incomplete or delayed medical decision-making.
  • The possibility that in-person care may be required for accurate diagnosis or treatment.

4. Patient Responsibilities

By using our Services, you agree to:

  • Provide accurate and complete information about your health.
  • Use a secure, private internet connection and device.
  • Follow treatment recommendations and seek in-person care when advised.
  • Call 911 or seek emergency services for life-threatening conditions.

5. Confidentiality & Privacy

  • Your health information will be protected under HIPAA and our Privacy Policy.
  • Electronic communications are encrypted, but no system is 100% secure.
  • You consent to the sharing of your health information with providers involved in your care.

6. Alternatives to Telehealth

You understand that you may seek in-person care as an alternative to telehealth services.

7. Consent

By checking the box below or proceeding with your appointment, you:

  • Confirm that you understand the benefits and risks of telehealth.
  • Authorize [Your Company Name] and its licensed providers to deliver care through telehealth.
  • Acknowledge that no guarantees have been made regarding outcomes.

✅ I have read and understand this Consent to Telehealth Treatment. I agree to receive care via telehealth.

8. Limitation of Liability

To the maximum extent permitted by law, [Your Company Name] and its providers are not liable for indirect, incidental, or consequential damages arising from use of our Services.

9. Termination

We may suspend or terminate your access to Services at any time if you violate these Terms, misuse the platform, or provide false information.

10. Governing Law

These Terms are governed by the laws of the state of Massachusetts. Any disputes shall be resolved in the courts of Massachusetts.

11. Changes to These Terms

We may update these Terms at any time. Continued use of Services after updates means you accept the revised Terms.

12. Contact Us

For questions about these Terms, contact us:
Simply Well Urgent Care
privacy@simplywellurgentcare.com

Great ✅ A Consent to Telehealth Treatment is essential for virtual urgent care. It confirms that patients understand what telehealth is, its limitations, and their rights. Here’s a clear, patient-friendly draft for your practice (you can present this as a check-box agreement before visits):