Telehealth and E-Visit Consent
I understand that I am a patient of KOH Physical Therapy Lab and I will be receiving my treatment via TELEHEALTH secure online platform.
I understand that the Telehealth sessions are hands-off sessions and will consist of detailed discussion regarding my condition, visual assessment of my movement patterns, balance, and range of motion.
I understand that I will be given home exercise program and home tips to allow me to progress towards my goals.
Informed consent for treatment: The term “informed consent” means that the potential risks,benefits and alternatives of physical therapy treatment have been explained to me. The therapist provides a wide range of services and I understand that I will receive information at the initial visit concerning the treatment and options available for my condition.
Potential risks: I may experience an increase in my current level of pain or discomfort, or an aggravation of my existing injury or condition. This discomfort is usually temporary; if it does not subside in a reasonable time period, I agree to contact my physical therapist.
Potential benefits: I may experience an improvement in my symptoms and an increase in my ability to perform daily activities. I may experience increased strength, awareness, flexibility, and endurance in my movements. I may experience decreased pain and discomfort. I should gain a greater knowledge about managing my condition and the resources available to me.
Alternatives: If I do not wish to participate in the therapy program, I will discuss my medical, surgical, or pharmacological alternatives with my physical therapist, as well as my physician or primary care provider.
Payment: I understand that I am responsible for full payment for this session. KOH Physical Therapy Lab may be an out of network provider. I understand that I may be responsible to bill my insurance for this session and I have checked with my insurance provider for possible reimbursement.
I have read the above information and I consent to physical therapy evaluation and treatment.
By clicking on “I AGREE”, I confirm that I have read all of the above information and I consent to physical therapy evaluation and treatment.