Telehealth/Telemedicine Consent

1. I hereby authorize Rock Landing Psychological Group to use the telehealth practice platform for telecommunication for evaluating, testing and diagnosing my condition.

2. I understand that technical difficulties may occur before or during the telehealth sessions and my appointment may not be started or ended as intended.

3. I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.

4. I understand that I will be responsible for any copayments, coinsurance, or deductibles that apply to my telehealth/telemedicine visit.

5. I agree that my medical records on telehealth can be kept for further evaluation, analysis and documentation, and in all of these, my information will be kept confidential.