Telehealth Informed Consent

ADHDAdvisor.org
support@adhdadvisor.org

ADHDAdvisor.org is responsible for assigning me to a health and wellness provider within its network for various services that will occasionally occur via telehealth.

I understand that my health and wellness provider, who is affiliated with ADHDAdvisor.org, wishes to have a telehealth consultation with me.

Telehealth means that through an interactive video connection, I will be able to consult with an ADHDAdvisor.org affiliated provider about my health and wellness concerns. I understand how telehealth will be used to do such consultation and how else we will use telehealth to connect while working together, using the Healthie telehealth platform. I consent to receive telehealth services using the Healthie platform and any other virtual connection, including but not limited to telephone when appropriate.

Potential Risks

• The video connection may not work, or it may stop working during the consultation.
• The video picture or information transmitted may not be clear enough to be useful for the consultation.

Potential Benefits

• I do not need to travel to the consult location.
• I have access to a specialist through this consultation.

I have read this document, understand the risks and benefits of the telehealth consultation, and have had my questions regarding the procedure explained. I hereby consent to participate in telehealth sessions under the conditions described in this document.

If the patient is under 18 years old, please reach out to support@adhdadvisor.org for more information.