Telehealth Informed Consent
Effective date: [date]
This document explains the benefits, risks, and alternatives of teledermatology with your licensed provider. Please read it carefully before consenting.
What telehealth is
Telehealth uses secure electronic communication so a provider in one location can review your information and care for you remotely. Your care may involve questionnaires, photos, store-and-forward review, secure messaging, and where required, live phone or video.
Potential benefits
Improved access and convenience, and the ability to be evaluated without traveling. Outcomes are never guaranteed.
Potential risks
- Information or images you provide may be insufficient for a remote assessment.
- Technology could fail or delay your evaluation.
- Visual or other cues available in person may be missed remotely.
- In rare cases, security measures could fail and your information could be exposed.
- Incomplete history could lead to a less accurate assessment.
What you are agreeing to
- You consent to receive care via telehealth, and understand your provider decides whether telehealth is appropriate for you.
- Your care is provided by a licensed provider; a prescription is not guaranteed and no controlled substances are prescribed.
- The alternative to telehealth is an in-person visit, and you may be referred for one if needed.
- This service is not for emergencies — call 911 in an emergency.
- You may withdraw your consent at any time without affecting your right to future care.
State-specific terms
[Attorney to add the additional consent language required by each state where Dr. Eckert is licensed.]
By starting a visit and checking the consent box, you confirm that you have read, understood, and agree to this consent.