Template only. California requires informed consent before the delivery of health care via telehealth, and the consent must be documented. This template must be reviewed and completed by counsel, and the executed consent should be captured through the patient portal rather than through this website.

What telehealth is

Telehealth is the delivery of health care services using interactive audio, video or other telecommunications technology, where the provider and patient are not in the same physical location.

Services available by telehealth at Aries Health and Wellness

Medical weight loss consultations — available in person or via telehealth
Initial BHRT consultations — conducted in person at our Palmdale clinic
Follow-up visits — may be conducted in person or via telehealth, at your provider's discretion

Expected benefits

Improved access to care without the need to travel
More flexible scheduling for follow-up appointments

Possible risks

Technology failure may delay or interrupt an appointment
The absence of a physical examination may limit your provider's clinical assessment
In rare cases, information transmitted may be insufficient for sound clinical decision-making, requiring an in-person visit
Although security protocols are used, there is a residual risk of unauthorized access to electronic communications

Your rights

You may withhold or withdraw consent to telehealth at any time without affecting your right to future care or treatment
You may request an in-person appointment at any time
Your provider may determine that telehealth is not appropriate for your situation and require an in-person visit
The laws protecting the confidentiality of your medical information apply equally to telehealth
[DESCRIBE ACCESS TO RECORDS AND DISSEMINATION RULES FOR ANY RECORDED IMAGES OR INFORMATION.]

Emergencies

Telehealth is not appropriate for medical emergencies. If you are experiencing an emergency, call 911 or go to your nearest emergency department. [DESCRIBE THE PROTOCOL FOR HANDLING AN EMERGENCY THAT ARISES DURING A TELEHEALTH VISIT, INCLUDING CONFIRMATION OF THE PATIENT'S PHYSICAL LOCATION AT THE START OF EACH VISIT.]

Licensure and location

[CONFIRM THE STATES IN WHICH THE PROVIDER IS LICENSED. Patients must generally be physically located in a state where the provider holds a licence at the time of the visit.]

Consent

[CONSENT LANGUAGE AND SIGNATURE CAPTURE TO BE COMPLETED BY COUNSEL AND EXECUTED THROUGH THE PATIENT PORTAL.]

How to contact us

Aries Health and Wellness
41324 12th St W
Palmdale, CA 93551
Email: arieshealthcorporation@gmail.com

Telehealth Consent