Telehealth (Televisit) Consent

Effective Date: April 10, 2026

IASIS Boutique Health
Concierge Internal Medicine
10730 W 143rd St, Suite 33
Orland Park, IL 60462
Phone: (708) 722-4300

What Is Telehealth?

Telehealth (also referred to as televisits or virtual visits) allows patients to receive medical care remotely using secure communication technologies such as video or phone consultations.

IASIS Boutique Health offers telehealth services to provide convenient, accessible care when in-person visits are not necessary.

Patient Consent for Telehealth Services

By participating in telehealth services with IASIS Boutique Health, you acknowledge and agree to the following:

1. Nature of Telehealth

• Telehealth involves the use of electronic communications to enable healthcare providers to diagnose, consult, treat, and educate patients remotely
• The same standards of care apply as in-person visits, but there may be limitations

2. Potential Risks

You understand that telehealth includes possible risks such as:

• Technical issues (poor connection, interruptions)
• Limited ability to perform physical examinations
• Potential delays in diagnosis or treatment
• Security risks despite safeguards

3. Privacy & Security

IASIS Boutique Health takes reasonable steps to protect your privacy and complies with HIPAA standards.

However, you understand that:

• No technology is completely secure
• There may be risks of unauthorized access despite safeguards

4. Patient Responsibilities

You agree to:

• Provide accurate and complete medical information
• Be in a private, appropriate location during the visit
• Use a secure internet connection whenever possible
• Follow medical advice and instructions provided

5. When Telehealth Is Not Appropriate

Telehealth may not be suitable for all medical conditions.

You agree that:

• IASIS Boutique Health may recommend an in-person visit when necessary
• You will seek emergency care when needed

6. Emergency Situations

Telehealth services are not intended for emergencies.

If you are experiencing a medical emergency:

• Call 911 immediately
• Go to the nearest emergency room

7. Recording of Visits

Telehealth sessions will not be recorded without your consent.

You agree not to record sessions without permission from IASIS Boutique Health.

8. Billing & Payment

Telehealth services may be:

• Included in your concierge membership, or
• Billed separately depending on your plan

You agree to any applicable charges prior to receiving care.

9. Right to Withdraw Consent

You have the right to:

• Decline telehealth services at any time
• Request an in-person appointment instead

10. Acknowledgment & Consent

By using telehealth services with IASIS Boutique Health, you acknowledge that:

• You have read and understand this consent form
• You agree to the terms outlined above
• You consent to receive care via telehealth

Contact Information

IASIS Boutique Health
 10730 W 143rd St, Suite 33, Orland Park, IL 60462
(708) 722-4300
hello@iasis.care