Telehealth Policy & Consent

In California, "Telehealth" is defined as a method to deliver health care services using information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient and provider are at two different sites. This form of service usually consists of live video conferencing through a personal computer with a webcam. At times this service may be provided by telephone, text message, online portal, or other web-based platform or application.

The Body Intuitive offers both online and in-person services. You are not required to use telehealth, but acknowledge that in-person sessions may have an additional cost affiliated such as personal time and funds for transportation, outcall fees, and other costs of services. You have the right to withhold or withdraw consent to telehealth services at any time without affecting your right to future care or treatment or risking the loss or withdrawal of any benefits to which you would otherwise be entitled.

By signing this consent form you are acknowledging that you have read and understand the following information provided, you have had the opportunity to discuss it with your provider, and all of your questions have been answered to your satisfaction:

• My provider explained to me how the video conferencing technology that will be used to engage in such services will not be identical to an in-person direct client/health care provider visit due to the fact that I will not be in the same room as my provider.

• I understand that a telehealth consultation has potential benefits including easier access to care and the convenience of meeting from a location of my choosing.

• I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my health care provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

• I have had a direct conversation with my provider, during which I had the opportunity to ask questions in regard to this procedure. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand.

• I acknowledge that there are always some risks with technology services including, but not limited to, the possibility that: telehealth may have disruptions or delays in the service and quality of the technology used; the transmission of your information could be intercepted by unauthorized persons; the recording and transmission of your medical information could be distorted by technical failures.
• Telehealth should not be viewed as a substitute for face-to-face counseling, therapeutic medication, medical treatment, or monitoring by a physician. It is an alternative form of treatment with certain limitations.
• Telehealth may not be appropriate if you are having a crisis, acute psychosis, or suicidal or homicidal thoughts.
• Telehealth may lack visual and/or audio cues, which may increase the likelihood of misunderstanding each other.

2. Policies for Telehealth Sessions 

• Telehealth sessions are not intended for medical emergencies, and must not be used for this purpose. If you are ever experiencing a medical emergency, please: call 911 or go to your nearest emergency room.
• The most reliable backup if there is technology failure is a phone. Always have a phone available and share your number with your provider. If we lose contact with you, or if you fail to show for a scheduled video conference, we may contact you by phone to check on you.
• Ensure that the private computer or device you use has updated operating and anti-virus software.
• Do not record sessions without first obtaining your therapist’s approval. Your provider will not record your sessions without your oral or written consent, as per the terms outlined in Company Policies & your Coaching waiver & liability agreement.
• Wear the same attire that you would normally wear to an in-person appointment.

• Hold the session in an appropriate, safe, and private room. Do not have anyone else in the room or within earshot, unless you first discuss it with your therapist.

• Do not conduct other activities while in session, such as driving.

• Tell your provider where you are located while taking the session. If you are not located within the state in which the clinician is licensed to practice, you must otherwise first obtain clearance from your provider for their ability to provide treatment and services in your current location.

• Do not bring any weapons of any kind to session.

• Avoid using mind-altering substances prior to, or during, session.

3. Consent to Use the Zoom Platform, Phone, and Conference Meeting/Recording Service and Dropbox as a secure Cloud Storage Software ("Telehealth Service Platform"):

• I understand that "telehealth" involves the use of audio, video, or other electronic communication to interact with you, consult with your provider, and/or review your case information for the purpose of evaluation, treatment, follow up and or education.
• During your telehealth session, details of your medical history and personal health information may be discussed through the use of interactive video, audio and telecommunications technology.
• Additionally, a physical exam may take place and video, audio or photo recordings may be taken with your consent.
• Zoom is the technology service we will use to conduct telehealth videoconferencing appointments. It is simple to use via both phone, internet, and offers options for both video and audio only sessions. There are no passwords required to log in.
• By signing this document, I acknowledge Zoom is NOT an Emergency Service and in the event of an emergency, I will use a phone to call 911.
• Though my provider and I may be in direct, virtual contact through the Telehealth Service Platform, neither Zoom, Dropbox, nor The Body Intuitive provide any medical or healthcare services or advice including, but not limited to, emergency or urgent medical services.
• The Telehealth Service Platforms facilitates videoconferencing and archiving of videoconferencing for the purpose of support client care delivery and treatment progress; the Telehealth Service Platforms are not responsible for the delivery of any healthcare, medical advice or care.
• You agree and consent to the knowledge that your provider does not have access to any or all of the technical information in the operations of the Telehealth Service Platforms – or that such information is current, accurate or up-to-date.
• You agree and certify that you will not rely on your TBI health care provider to have any of this information in the Telehealth Service Platforms.
• To maintain confidentiality, you agree that youu will not share my telehealth appointment link with anyone unauthorized to attend the appointment.

4. Confidentiality for Telehealth Services

In accordance with professional ethical standards and state and federal law, all services provided by The Body Intuitive are kept confidential and are only released upon your written request or as noted in this section. Records are only accessed by staff as needed to ensure quality care and in accordance with accepted professional practice. The Body Intuitive keeps confidential electronic records of your visits, as required by practice guidelines and current standards of care.

 The Body Intuitive has an ethical and potentially a legal responsibility to disclose client information without prior consent in the following situations:

• There is a reasonable suspicion of serious threat to your health and safety or the health and safety of the public or another person.
• There is reasonable suspicion of abuse of children (including viewing child pornography), dependent adults or the elderly.
• Your physical or mental impairment prevents you from being able to care for yourself.
• There is a valid court order for the disclosure of your files.
• In addition to the situations outlined above, staff may be legally or professionally obligated to report injuries they know or reasonably suspect were the result of abuse.

Client rights, recitals, and certifications: 

• I understand that there are limitations to the types of treatment that can be appropriately provided via telehealth, and that my provider determines whether or not it is appropriate for me to receive treatment via telehealth.
• The laws that protect the confidentiality of my medical information also apply to telehealth.
• I understand that I may benefit from telehealth, but that results cannot be guaranteed or assured. The benefits of telehealth include access to specialists, information, and education without having to travel to see my provider.
• I understand that there are risks involved in receiving treatment via telehealth, such as interruption of the audio-video connection between me and my provider, or delays in receiving treatment because of technological failures.
• I understand that I have a right to access my personal health information and copies of records in accordance with applicable California and federal law. All laws concerning patient access to records apply to telehealth. Dissemination of any patient identifiable images or information from the telemedicine consultation to research or other entities shall not occur without your consent.
• I hereby consent to receiving treatment through telehealth from The Body Intuitive

• I understand that my health care provider and I are agreeing to engage in somatic therapy and health coaching services by way of a telehealth online video platform such as Zoom.

• I understand that receiving treatment through telehealth does not mean I cannot receive in-person health care services, either today or in the future.

• I have read or had this form read and/or had this form explained to me.

• I fully understand its contents including the risks and benefits of telehealth.

• I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction.

• I understand that I can discuss any questions that I have with my provider at the beginning of my telehealth consultation, that my provider will answer any such questions, and that I may decline to continue the telehealth consultation at any time.
• I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment or risking the loss or withdrawal of any program benefits to which I would otherwise be entitled.

BY SIGNING THE WAIVER & CLICKING ON THE CHECKBOX BELOW, I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

{Check box and signature provided on client intake forms when signing up for services}

REVISION DATE
This version of the telehealth policy went into effect on 08/12/2025.