Virtual Clinical Visit Consent – Patient Information

Before you are scheduled for a virtual visit, here are a few things to know.


  • We use video and audio technology so we can see and hear each other
  • We recommend you be in a quiet place for your virtual visit so that others cannot overhear the
    session (unless you want to include others in your visit – please tell us who is with you)
  • You will be asked for details of what is happening and your health history – these questions may
    be very personal and sensitive
  • Details of your virtual visit will be recorded in your health record just like in an in‐person visit
  • We will not make a recording of the virtual visit. We ask that you not record the visit either.
  • We may ask to take photographs if necessary to treat you – we will tell you before we take any


  • Virtual visits are not appropriate for emergencies – please call 9‐1‐1
  • A virtual visit may not be an option for you if the assessment requires a physical examination
  • Time may be limited based on the availability of our staff during the pandemic
  • This service may not be available after the pandemic – we may need to end it at any time


  • We have taken appropriate steps to preserve your privacy based on this emergency situation
  • However, we cannot provide you with the same guarantee of security and confidentiality as if you were seen in person
  • Our staff who are doing the virtual visit may be working from home because of the pandemic – they will also try to find a quiet place away from others in their household


  • It is possible there could be a problem with the technology and your session could be cut short or interrupted
  • The quality of the video or audio may not be good enough for a health care provider to assist you virtually or could negatively impact the quality of the care you receive

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