Telehealth Informed Consent — Continuum Teletherapy and Allied Health

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 & Allied Health does not record sessions without my explicit consent, and 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 without affecting my right to receive alternative care

I consent to receiving health information, appointment reminders, and service updates from Continuum Teletherapy & Allied Health via email

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?