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TELEHEALTH CONSENT

ZOE Integrated Wellness, PLLC
Last Updated: 03/24/26

This Telehealth Consent outlines your rights, responsibilities, and the conditions under which telehealth services are provided by ZOE Integrated Wellness, PLLC. Please read carefully before participating in telehealth sessions.


1. What Is Telehealth

Telehealth involves the use of electronic communications (video, phone, or secure messaging) to provide clinical services when you and your provider are not in the same location.


2. Potential Benefits

  • Increased access to care

  • Convenience and reduced travel time

  • Continuity of care when in‑person sessions are not possible


3. Potential Risks

While telehealth is generally safe and effective, risks may include:

  • Technology failures or interruptions

  • Limited ability to observe nonverbal cues

  • Security vulnerabilities despite reasonable safeguards


4. Confidentiality and Privacy

Your privacy is protected under HIPAA and state law.
ZOE Integrated Wellness, PLLC uses secure, encrypted platforms for telehealth.

Important:
No mobile opt‑in or text message consent will be shared with third parties or affiliates.

Confidentiality may be broken only in legally required situations such as:

  • Risk of harm to self or others

  • Suspected abuse or neglect

  • Court orders


5. Client Responsibilities During Telehealth

You agree to:

  • Participate from a private, quiet, and safe location

  • Use a secure internet connection (not public Wi‑Fi)

  • Ensure your device is functioning properly

  • Not record sessions without written permission

  • Inform your provider of your physical location at the start of each session (required for emergency purposes)


6. Emergency Procedures

Telehealth is not appropriate for emergencies.
If you are in crisis or immediate danger, call 911 or go to the nearest emergency room.

You must provide:

  • Your current physical address at each session

  • An emergency contact who may be reached if safety concerns arise


7. Appropriateness of Telehealth

Your provider may determine that telehealth is not clinically appropriate and may recommend in‑person care or referral.


8. Consent to Telehealth By signing this consent (physically or electronically), you acknowledge that:

  • You understand the risks and benefits of telehealth

  • You agree to participate voluntarily

  • You may withdraw consent at any time

  • You understand that telehealth may not be suitable for all clinical needs


9. Contact Information

For questions about telehealth services, please contact:

ZOE Integrated Wellness, PLLC
Email: zoewellness07@gmail.com
Phone: 928-395-5803

Website: www.zoeintegratedwellness.net

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