1. I understand that a telehealth consultation will not be the same as a direct patient/health care provider visit due to the fact that I will not be in the same room as my health care provider.

2. I understand there are potential risks to this technology, including interruptions, unauthorized access and technical difficulties. I understand that my health care provider or I can discontinue the telemedicine
consult/visit if it is felt that the videoconferencing connections are not appropriate for the situation.

3.  I understand that my provider will conduct the session in a private location alone and will not be recording the session.  I will be informed in advance before anyone else would be present in the telehealth session.

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4.  I agree not to record or share the content of my telehealth visit. I agree to conduct the visit in a private space without any other attendees present, or able to hear or see my visit, unless an alternative arrangement is agreed to by me and my provider. If someone comes into the room during my visit, I agree to pause the video and restart only after they have left.

5.  I understand that billing will occur at the same rate as if I were seen in person, regardless of whether my insurance covers the costs.

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6.  I attest that I am physically located in the State of Illinois at the time of this session. 

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7.  I agree not to attend the session under the influence of alcohol or other substances.

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8.  I agree not to attempt to conduct the session while driving or riding as a passenger in a vehicle.