Telehealth Informed Consent

This Telehealth Informed Consent (“Consent”) describes care delivered by telehealth through Next Play Health. By using the Services for care, you confirm that you have read and agree to this Consent.

1. What telehealth is

Telehealth is healthcare delivered through electronic communication, such as secure questionnaires, messaging, phone or video, between you and a licensed clinician who may be in a different location. It allows evaluation, diagnosis, treatment and follow-up without an in-person visit.

2. How your care works

• Your care is provided by an independent clinician licensed in your state, using the information you give during intake and follow-up.
• A telehealth visit may not include a physical examination, so your care depends on the information you provide. It is important that it is accurate and complete.
• Your clinician decides whether telehealth is right for your needs, and may decide that you need in-person care, more testing or a referral.

3. Benefits

• Access to licensed care without travel or waiting rooms.
• Convenient follow-up and secure communication with your care team.
• Coordinated prescriptions, pharmacy dispensing and lab testing where appropriate.

4. Risks and limits

• Without a physical exam, a condition could go undetected, or a clinician could reach a different conclusion than they would in person.
• Technical problems can interrupt a visit or affect its quality.
• Despite reasonable safeguards, electronic communication carries some risk to privacy and security.
• Telehealth is not suitable for emergencies. If you have a medical emergency, call 911 or go to the nearest emergency room.

5. Prescriptions

Any prescription is issued at your clinician’s independent clinical judgment, and only when appropriate. Completing an intake does not guarantee a prescription. Some treatments may be compounded medications, which are not FDA-approved; your clinician will discuss their risks and benefits with you.

6. Privacy of your health information

Your health information is handled as described in our Privacy Policy and protected under HIPAA by the clinicians, pharmacies and laboratories who treat you. Telehealth visits are documented in your medical record.

7. Your rights

• You may refuse or withdraw your consent to telehealth at any time without affecting your right to future care or treatment.
• You may ask for a referral to in-person care instead.
• You have the right to have your questions answered before you agree to care.

8. Consent to treatment

By continuing, you consent to receive care by telehealth as described here, you confirm that the information you give is accurate, and you understand that the clinician-patient relationship is between you and your independent clinician. If you do not agree, please do not continue with a telehealth visit.

9. Contact us

Questions about telehealth care? Email [email protected].