Telehealth Informed Consent

What Telehealth Means

Telehealth involves the use of electronic communication technology to provide or support healthcare-related services when the patient and provider are not physically in the same location.

Telehealth may include:

• Secure video appointments
• Audio communication when clinically appropriate
• Electronic intake forms
• Secure messaging or patient portal communication
• Electronic prescribing when legally and clinically appropriate
• Remote coordination of care
• Electronic exchange of treatment-related information

Consent to Receive Services Through Telehealth

By using telehealth services, you voluntarily consent to receiving services through electronic communication technology.

You understand that telehealth may be used for future psychiatric evaluation, medication management, consultation, care coordination, follow-up appointments, education, and other appropriate services provided by Welch Psychiatric Group.

You understand that telehealth is not appropriate for every condition, situation, or level of risk. Welch Psychiatric Group may determine that telehealth is not clinically appropriate and may recommend in-person evaluation, emergency care, a higher level of care, or referral to another provider.

Benefits of Telehealth

Telehealth may offer benefits including:

• Improved access to care
• Convenience and reduced travel time
• Ability to attend appointments from a private location
• Continuity of care during scheduling, transportation, illness, childcare, or distance-related barriers
• Improved access for individuals in rural or underserved areas when legally permitted

Risks and Limitations of Telehealth

Telehealth has risks and limitations. These may include, but are not limited to:

• Technology failures, internet disruption, audio or video problems, or platform outages
• Delays in evaluation or treatment due to technology issues
• Privacy risks if sessions are accessed from a non-private location
• Security risks related to electronic communication despite reasonable safeguards
• Limited ability to observe certain nonverbal cues, physical symptoms, or environmental factors
• Inability to perform a full physical examination
• Potential need for in-person care, laboratory testing, vital signs, medical evaluation, or emergency services
• Potential limitations in treating higher-risk psychiatric symptoms through telehealth alone

No electronic communication system can guarantee complete security or uninterrupted access.

Technology Failures and Backup Plan

Technology problems may occur during telehealth sessions. If a connection is lost, audio or video fails, or the platform becomes unavailable, Welch Psychiatric Group may attempt to reconnect, contact you by phone, reschedule the appointment, or determine another appropriate next step.

You agree to provide a reliable phone number where you can be reached during the appointment in case of technology failure.

If a telehealth session cannot be completed due to technology issues, the appointment may need to be rescheduled, converted to another appropriate format, or handled according to clinical judgment and applicable law.

Patient Location Requirement

You must disclose your physical location at the beginning of each telehealth appointment.

Future psychiatric services are anticipated to be available to patients physically located in Colorado at the time of service, unless Welch Psychiatric Group is legally authorized to provide care in another state or jurisdiction.

If you are outside Colorado or in a location where Welch Psychiatric Group is not legally permitted to provide services, the appointment may need to be canceled, rescheduled, or referred to another provider.

Emergency Procedures

Welch Psychiatric Group does not provide emergency, crisis, or 24/7 services.

If you are experiencing a mental health emergency, thoughts of harming yourself or someone else, psychosis, severe withdrawal symptoms, overdose risk, inability to remain safe, or another urgent concern, do not wait for a scheduled appointment or message response.

Please use one of the following emergency resources:

• Call 911
• Call or text 988 for the Suicide & Crisis Lifeline
• Contact Colorado Crisis Services at 1-844-493-TALK (8255)
• Go to the nearest emergency department

During telehealth services, if safety concerns arise, Welch Psychiatric Group may contact emergency services, crisis services, your emergency contact, or other appropriate supports as permitted or required by law.

Emergency Contact Requirement

You may be required to provide an emergency contact before receiving telehealth services.

Your emergency contact may be contacted if Welch Psychiatric Group has concern for your safety, is unable to reach you during a crisis or urgent safety concern, or believes contact is clinically necessary and permitted or required by law.

You are responsible for keeping emergency contact information current.

Privacy During Telehealth Sessions

Welch Psychiatric Group will take reasonable steps to protect your privacy during telehealth services.

You are responsible for:

• Attending sessions from a private and safe location
• Using a secure internet connection when possible
• Using headphones when helpful for privacy
• Preventing unauthorized people from hearing or viewing the session
• Protecting login information, portal access, and passwords
• Informing the provider if another person is present or can hear the session

Public places, shared rooms, workplaces without privacy, moving vehicles, or other non-private settings may not be appropriate for telehealth appointments.

Recording Prohibited

Telehealth sessions may not be recorded, photographed, livestreamed, transcribed, screenshotted, duplicated, or shared by you or anyone present without prior written consent from Welch Psychiatric Group and all participants.

Welch Psychiatric Group will not record telehealth sessions without appropriate consent.

Unauthorized recording or sharing of telehealth sessions may result in termination of services and may have legal consequences.

Alternative Treatment Options

You understand that telehealth is one method of receiving services and that alternative options may include in-person psychiatric care, primary care, therapy, urgent care, emergency services, higher levels of psychiatric care, intensive outpatient programs, partial hospitalization programs, residential treatment, or inpatient hospitalization.

You may decline telehealth services and seek in-person or alternative care elsewhere.

Welch Psychiatric Group may recommend a different type or level of care if telehealth is not appropriate for your clinical needs.

Controlled Substances Considerations

Controlled substance prescribing through telehealth is subject to federal law, state law, professional standards, clinical judgment, pharmacy requirements, and applicable regulations.

Controlled substances are never guaranteed. This includes stimulants, benzodiazepines, sedative-hypnotics, certain sleep medications, and other regulated medications.

Controlled substance prescribing may require:

• Comprehensive evaluation
• Review of prior records
• Prescription monitoring program review
• Urine drug screening when clinically appropriate
• Treatment agreement
• Vital signs or medical evaluation
• Regular follow-up appointments
• Coordination with other providers
• In-person evaluation or referral when required or clinically appropriate

Welch Psychiatric Group reserves the right to decline, discontinue, or modify controlled substance treatment when it is not clinically appropriate, unsafe, outside the scope of care, or inconsistent with legal or professional standards.

Patient Responsibilities

By participating in telehealth services, you agree to:

• Provide accurate identifying information
• Provide your current physical location at each appointment
• Provide an accurate emergency contact
• Attend appointments from a private and safe location
• Use reliable technology and internet when possible
• Be on time for appointments
• Participate without driving, operating machinery, or being in unsafe circumstances
• Inform the provider if another person is present
• Notify the provider of changes in symptoms, medications, substances, medical conditions, or safety concerns
• Use emergency services for emergencies rather than relying on portal messages, emails, texts, or scheduled appointments

Provider Responsibilities

Welch Psychiatric Group will make reasonable efforts to:

• Use appropriate telehealth technology
• Protect privacy and confidentiality
• Evaluate whether telehealth is clinically appropriate
• Maintain professional standards of care
• Document services appropriately
• Discuss relevant risks, benefits, and limitations
• Recommend alternative or higher-level care when clinically indicated
• Respond to safety concerns according to clinical judgment and applicable law

Limitations of Online Communication

Portal messages, email, text messages, voicemail, website forms, and other electronic communication methods may not be reviewed immediately.

These communication methods should not be used for emergencies, urgent medication concerns, suicidal thoughts, threats of harm, severe symptoms, or rapidly worsening conditions.

Routine communication may be addressed during business hours and within the timeframe established by Practice policy.

Consent May Be Withdrawn

You may withdraw consent for telehealth services at any time by notifying Welch Psychiatric Group in writing.

Withdrawing consent may affect Welch Psychiatric Group’s ability to continue providing services if in-person care is not offered or clinically appropriate alternatives are unavailable.

Acknowledgment and Consent

By participating in telehealth services, you acknowledge that you have read and understood this Telehealth Informed Consent, had the opportunity to ask questions, understand the risks and benefits of telehealth, and voluntarily consent to receive services through telehealth when clinically appropriate.

You also acknowledge that additional agreements, including the Notice of Privacy Practices, Financial Policy, Cancellation Policy, Life Coaching Agreement, and service-specific consents, may apply.