Telehealth Informed Consent
1. Important Emergency Notice
Telehealth is not for emergencies. If you are experiencing a medical emergency, a mental-health crisis, or thoughts of harming yourself or others, call 911 or go to the nearest emergency department right away. Do not wait for a reply from a Provider, a message, or a scheduled visit.
Telehealth visits, secure messages, and support requests are not monitored around the clock and are not a substitute for emergency services. If you need urgent help and are unsure where to turn, contact local emergency services or a crisis line available in your area.
2. Parties and Purpose of This Consent
This consent is between you and the independent professional entity that provides clinical care to you through the Telepartners Studio platform (the “Practice”), together with the independent licensed healthcare professionals who provide care on its behalf (each a “Provider”). The Practice and its Providers are solely responsible for clinical decisions, treatment, and the medical records they create.
Telepartners Studio is a telehealth operating and growth partner. It supplies non-clinical technology, scheduling, patient-support, marketing, and payment-administration services to the Practice. Telepartners Studio is not a healthcare provider, a prescriber, or a pharmacy, does not practice medicine, and does not direct or influence a Provider’s independent medical judgment.
The purpose of this document is to give you the information you need to decide whether to receive care by telehealth, and to record your informed and voluntary decision.
3. Voluntary Consent and Acknowledgment
By accepting this consent, you confirm that:
- you have read this document, or had it explained to you, and your questions have been answered to your satisfaction;
- you are at least eighteen (18) years old;
- you are physically located in the state you reported for each visit at the time that visit takes place; and
- you are choosing to receive care by telehealth of your own free will.
Your consent is voluntary. You may decline telehealth, or withdraw your consent for future telehealth services at any time by notifying the Practice. Withdrawing consent does not affect care already provided, and it will not by itself result in the loss of any right you may have under applicable law.
4. What Telehealth Means
Telehealth is the delivery of healthcare services remotely, using secure electronic communication instead of an in-person visit. Depending on your needs and what a Provider considers appropriate, telehealth may include:
- live video or telephone visits;
- secure messaging through a patient portal;
- review of health questionnaires, histories, and information you submit;
- review of laboratory results or other information relevant to your care; and
- coordination of prescriptions, laboratory orders, and follow-up with pharmacies and other providers.
The Provider decides whether telehealth is clinically appropriate for you, and may change that decision at any time, including recommending that you be seen in person.
5. Benefits, Risks, Limitations, and Alternatives
Telehealth has advantages and drawbacks. Please consider both before agreeing to proceed.
| Topic | What you should know |
|---|---|
| Possible benefits | Greater convenience, faster access to care, no travel or waiting room, easier scheduling, and access to Providers who may not be available locally. |
| Technology risks | Connections can fail, video or audio quality can be poor, and equipment or software can malfunction. This may delay or interrupt a visit or require it to be rescheduled. |
| Privacy risks | Using public or unsecured networks, shared devices, or locations where others can overhear may expose your information despite security safeguards. |
| Clinical limitations | A Provider cannot perform a hands-on physical exam or certain tests remotely. Important findings could be missed, and the Provider may need additional information or an in-person evaluation. |
| Possible need for other care | A Provider may decide that telehealth is not suitable and refer you for in-person, urgent, or emergency care. Costs of that care are separate and are your responsibility unless agreed otherwise. |
| No guaranteed outcome | No result, improvement, or prescription can be promised. Individual results vary. |
Alternatives. You may choose an in-person visit with a local healthcare professional, seek urgent or emergency care when appropriate, or choose not to receive treatment. Each alternative has its own benefits and risks, which you may discuss with a Provider.
6. Provider Identity, Licensure, and Clinical Judgment
Providers are independent licensed professionals who are authorized to practice in the state where you are located at the time of each visit. You may ask a Provider about their credentials, license, and role at any time.
All diagnosis and treatment decisions are made by the Provider using independent clinical judgment. A Provider may decline to treat you, decline to prescribe a particular medication, change a treatment plan, or end the care relationship where permitted by law, if they believe it is not safe, appropriate, or lawful. Telepartners Studio does not make or override these decisions.
7. Your Responsibilities as a Patient
To help your Provider care for you safely, you agree to:
- give complete, accurate, and current information about your identity, location, medical history, medications, allergies, and symptoms;
- tell the Provider promptly about any change in your health, medications, or location;
- be in a private location, in the state you reported, with a reliable internet connection for each visit;
- follow the treatment plan and instructions you are given, and tell the Provider if you cannot or do not wish to;
- keep your account credentials and devices secure and not share access with anyone; and
- seek in-person or emergency care when your Provider advises it or your condition requires it.
8. Privacy, Security, and Health Information
The Practice and its Providers are responsible for protecting your health information in accordance with HIPAA and applicable state law. Telepartners Studio may handle certain information on the Practice’s behalf to provide non-clinical services, under written agreements where required by law.
We use technical, administrative, and physical safeguards designed to protect information shared during telehealth. No electronic system is completely secure, and you accept that some risk remains. The Practice’s Notice of Privacy Practices explains how medical information may be used and disclosed and describes your rights. Information collected through our public website is described in our Privacy Policy.
Please do not send health information through ordinary website forms, social-media messages, or unencrypted email. Use the secure patient portal or other channel your care team directs you to.
9. Others Present, Interpretation, and Recording
Others present. You should tell the Provider if anyone else is in the room with you. Others may also be present on the Provider’s side, such as clinical staff or interpreters. You may ask who is present at any time.
Interpretation. If you need an interpreter or other communication support, tell us before your visit so reasonable arrangements can be made where available.
Recording. Visits are not recorded or photographed by you or by anyone else unless all participants have clearly agreed beforehand and applicable law allows it. Do not record a visit without the Provider’s knowledge and permission. Any images or information you share for clinical purposes become part of your medical record.
10. Prescriptions, Pharmacies, and Medications
- A prescription is never guaranteed. Whether one is issued depends on the Provider’s clinical judgment, your health information, and the laws that apply where you are located.
- If a prescription is issued, it is sent to a licensed pharmacy. You may ask about your pharmacy options, subject to what is available for your treatment.
- Pharmacies are independent from the Provider and from Telepartners Studio, and they make their own decisions about filling, shipping, and substituting medications.
- Some medications are compounded. Compounded medications are not FDA-approved in the way commercially approved drugs are, and they are not reviewed by the FDA for safety, effectiveness, or quality before being marketed. They are dispensed only against a valid prescription from a licensed Provider.
- Report side effects, allergic reactions, or concerns to your Provider promptly, and seek emergency care for severe symptoms.
- Certain controlled substances are subject to additional legal restrictions and may not be available through telehealth.
11. Treatment-Specific Disclosures
Some treatments carry risks, side effects, contraindications, or monitoring requirements beyond the general information in this document. Before you begin a particular treatment, the Provider will review it with you, and you may receive additional written information or a separate consent. You are encouraged to ask questions and to decline any treatment you do not understand or do not want.
Weight-management, hormone, wellness, and similar programs may require laboratory testing, follow-up visits, and lifestyle changes, and may not be suitable for everyone. Results differ from person to person and are not guaranteed.
12. Cash-Pay Financial Responsibility
Services are offered on a cash-pay basis unless you are told otherwise in a written disclosure. This means that you are responsible for the fees shown to you at checkout, and that the Practice does not bill health insurance, Medicare, or Medicaid for these services unless stated.
Payment for a visit or program does not guarantee a prescription or a particular outcome. Medications, laboratory tests, in-person care, and services from third parties may carry separate charges. Refund and cancellation terms, if any, are provided at the time of purchase. Payment administration may be handled by Telepartners Studio on the Practice’s behalf.
13. Appointment, Treatment, and Care-Related Communications
By providing your contact details, you agree that the Practice and Telepartners Studio, acting on its behalf, may contact you by email, telephone, secure portal message, and text message about appointments, reminders, treatment instructions, refills, payments, and other care-related matters. Messages may contain limited information, and you are responsible for the privacy of the devices you use to receive them.
Message and data rates may apply to text messages. You can opt out of text messages by replying STOP, and you can ask for help by replying HELP. Opting out of non-essential messages will not affect your ability to receive care, but you may still receive necessary account, safety, and clinical notices through another channel. Consent to marketing communications is separate, optional, and is not a condition of receiving care.
14. Access to Records, Follow-Up, and Complaints
Records. You may request access to, or a copy of, your medical records from the Practice, as provided in its Notice of Privacy Practices and by law.
Follow-up. Ask clinical follow-up questions through the secure patient portal, or contact patient support to be directed to your care team. Do not use general website forms or social media for clinical questions.
Complaints. If you have a concern about your care or this service, you may raise it with the Practice, with patient support, or with the state licensing board that oversees your Provider. We will not retaliate against you for raising a concern.
For questions about this document, patient support, or privacy, contact:
Company: Telepartners Studio
Phone: +1 973 370 7000
Email: info@telepartnersstudio.com
Website: telepartnersstudio.com
Privacy requests: Email us with the subject line “Privacy Request,” “Privacy Opt-Out,” or “Privacy Request Appeal.”
In an emergency, call 911 or go to the nearest emergency department.
15. State-Specific Disclosures and Addendum
Telehealth laws differ from state to state. Some states require additional disclosures, specific consent language, rules about Provider licensure, or limits on what may be prescribed by telehealth. Where your state requires more, a state-specific addendum will be provided to you before care begins, and it forms part of this consent.
If this document and a state addendum conflict, the version that gives you greater protection under the law applies.
16. Consent, Electronic Signature, and Copy
By selecting the acceptance option, typing your name, or otherwise signing electronically, you confirm that you have read and understood this Telehealth Informed Consent, that your questions have been answered, and that you voluntarily agree to receive care by telehealth. Your electronic signature has the same legal effect as a handwritten one.
We record your name, the date and time of acceptance, the version of this document, and the signature or acceptance you provide. You may ask for a copy of this consent at any time, and a copy will be available through the secure workflow or on request. Consent applies to the services described here until you withdraw it or this document is replaced by an updated version.