Telehealth Informed Consent, Continuum Teletherapy and Allied Health

halaxy_patient_id

halaxy_appointment_id

practitioner

Complex Care Consultation (Multidisciplinary)

I understand that my appointment will be delivered via telehealth (video and/or audio technology) and not in person

I understand that technical difficulties may interrupt my session and that my clinician will contact me by phone if this occurs

I understand that I am responsible for ensuring my environment is private during my telehealth session and I will inform my clinician if others are present

I understand that Continuum Teletherapy and Allied Health does not store a recording of my session, that where an AI scribe is used my conversation is processed as it happens only to draft the written note, and that I will inform my clinician if I wish to record my session

I consent to my personal health information being securely stored in Halaxy (Australian-hosted clinical software) in accordance with the Privacy Act 1988

I understand that if my clinician identifies an immediate risk to life or safety, emergency services (000) may be contacted and relevant information may be provided to first responders

I understand that I may request an in-person referral at any time if telehealth is not appropriate for my needs, and that my clinician will assist me in accessing in-person care if required

I understand that my participation in telehealth services is voluntary and that I may withdraw my consent at any time, before or during an appointment, without affecting my right to receive alternative care

I understand that Continuum uses Australian hosted AI tools for phone reception, clinical note taking, and drafting oral health care plans, that a registered practitioner reviews and approves all clinical output, and that I may decline the use of any of these tools without affecting my care

Yes, the Continuum clinicians involved in my care may share relevant clinical information between them so that my care is coordinated

No, I would prefer each clinician works only from their own appointments with me

I would like to receive general health information, resources and service updates from Continuum by email. This is optional. Appointment reminders and information about my own care are part of my care and will be sent to me regardless. My decision here has no effect on my access to care.

Telehealth Informed Consent, Continuum Teletherapy and Allied Health

Your Details

Full legal name

Date of birth

Email address

Phone number

Which service are you consenting for?