Informed Consent to Telehealth

Telehealth is the delivery of healthcare services through electronic communications — in our case, a live, two-way secure call (audio by default, video when your provider determines it is needed) between you and a licensed provider. You will not be in the same physical location as your provider.

• Access to a licensed provider without traveling to an office
• Faster and more convenient appointments for non-emergency concerns
• Reduced exposure to contagious illnesses in waiting rooms
• Continuity of care through follow-up messaging

You acknowledge and understand that:

• Telehealth is not a substitute for in-person emergency care. If you have a medical emergency, call 911 or go to the nearest emergency room.
• Your provider cannot perform a hands-on physical examination, which may limit diagnostic accuracy for some conditions.
• Technology failures (poor internet, audio/video issues, power outages) may interrupt or prevent the visit. If a visit cannot be completed, we will reschedule you at no additional charge.
• In rare circumstances, security protocols may fail and result in a breach of PHI. We use HIPAA-compliant platforms to minimize this risk.
• Your provider may determine that your condition requires in-person evaluation and will refer you to an appropriate in-person provider. In that case, you may still be responsible for the visit fee.
• Not all prescriptions can be issued via telehealth (see our Terms of Service, Section 7).

You have the right to:

• Withhold or withdraw consent to telehealth at any time without affecting your right to future care
• Request an in-person visit with another provider instead of telehealth (Crescent Health does not offer in-person visits directly)
• Have all information obtained during your visit treated as confidential PHI under HIPAA
• Access and obtain copies of your medical records
• Be informed of the identity and credentials of any provider involved in your care

Your visit will be conducted over a HIPAA-compliant telehealth platform. Crescent Health does not record visits. You agree not to record or transmit the visit (audio or video) without the express written consent of Crescent Health and your provider.

You confirm that you will be physically located in Georgia or Alabama at the time of your visit. Your provider is licensed to practice medicine in Georgia and Alabama only. Care provided outside these states would violate state medical practice laws, and we cannot see you if you are located elsewhere at the time of the appointment.

If during your visit you experience a medical emergency, your provider will instruct you to call 911 or proceed to the nearest emergency room. You agree to provide your current physical address at the start of each visit so that emergency services can be directed to you if needed.

Prescriptions are issued solely at the clinical discretion of the provider. We do not prescribe controlled substances, GLP-1 medications for weight loss, or any medication requiring in-person examination under the applicable standard of care.

The standard self-pay fee is $59 per visit, collected at booking. A written Good Faith Estimate will be provided by email under the federal No Surprises Act. See our Terms of Service for the full fee, cancellation, and refund policy.

By completing your Patient Intake Form and attending your visit, you acknowledge that:

• You have read and understood this Informed Consent
• You have had the opportunity to ask questions about telehealth and had them answered
• You voluntarily consent to receive healthcare services via telehealth from Crescent Health
• You may withdraw this consent at any time in writing by emailing admin@crescent-telemed.com

For any questions about this consent, email admin@crescent-telemed.com before your appointment.