Telehealth Attestation

Telehealth Attestation & Consent

Last updated: November 18, 2025

By continuing, you acknowledge and agree to the following:

  1. Regulatory Requirements

    Telehealth services are provided in accordance with current federal and state laws and regulations. These requirements are subject to change based on government action, including potential federal funding lapses or regulatory updates.

  2. Patient Circumstances

    You attest that you are unable to reasonably access in-person care at this time due to one or more of the following: geographic distance, transportation barriers, mobility limitations, heightened risk of exposure to communicable illness, or lack of available local providers.

  3. Consent to Telehealth

    You consent to receive services via telehealth, including by secure audio/video connection. You understand that telehealth may limit certain aspects of physical examination but is otherwise clinically appropriate and medically necessary for your care.

  4. Risks and Benefits

    You understand that telehealth carries potential benefits (increased access, convenience, continuity of care) as well as potential risks (technical failures, limited physical examination). Your provider will exercise judgment to ensure the quality and appropriateness of your care.

  5. Emergency Care

    You understand that telehealth is not a substitute for emergency medical services. In the event of an emergency, you should call 911 or proceed to the nearest emergency department.

You acknowledge that you have read, understood, and agree to the above terms, and you consent to receive

Scroll to Top