Speech Therapy Telehealth Consent Document

This consent form is intended to inform you about speech therapy services delivered remotely (telehealth). Please carefully read the information below before signing.

1. Telehealth Description

Telehealth involves the use of audio, video, or other electronic methods for speech therapy sessions, providing care when you and your clinician are not in the same location.

2. Potential Benefits

• Access to services that might not otherwise be available.
• Continuity of care with your provider.
• Reduced travel time and related costs.

3. Potential Risks

• Services may be disrupted or distorted by technical failures.
• In rare cases, security protocols could fail and result in a breach of privacy.

4. Confidentiality

Reasonable measures will be taken to ensure confidentiality, but telehealth may carry risks that are different from in-person sessions.

5. Consent and Agreement

By signing below, you acknowledge that you have read and understand this consent document and agree to receive speech therapy services through telehealth.