Telehealth

Telehealth Consent Form

1. I hereby authorize Lifting Stigmas and Changing Lives to use the telehealth practice platform for telecommunication for evaluating, testing, and diagnosing my medical condition.

2. I understand that technical difficulties may occur before or during the telehealth sessions, and my appointment cannot be started or ended as intended.

3. I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.

4. I understand that my current insurance may not cover the additional fees of the telehealth practices and I may be responsible for any expense that my insurance company does not cover.

5. I agree that my medical records on telehealth can be kept for further evaluation, analysis and documentation, and in all of these, my information will be kept private.

    Address

    8409 Harford Road Baltimore, MD 21234

    Hours
    Hours 8:00 -5:30 pm
    Phone

    410-656-3906

    Fax

    410-665-2632