1 · Nature of Telehealth Services

Telehealth visits with Dr. Wong are conducted over a HIPAA-compliant video or telephone platform. The visit is functionally similar to an in-person visit but the provider is at a separate physical location. Care provided by telehealth is medical care; the same professional and ethical standards apply.

2 · Patient Location and Licensure

Dr. Wong is licensed to practice medicine in the State of California. I agree that I will be physically located within California during every telehealth visit. If I am temporarily outside California, I will notify Dr. Wong before the visit, and the visit may need to be rescheduled or limited to non-clinical matters.

At the start of each visit, I agree to confirm my current physical address and a phone number where I can be reached if the connection drops, so that emergency services can be directed to me if necessary.

3 · Benefits

• Continuity of care without travel;
• Greater scheduling flexibility;
• Access to care from home or another private location of your choosing.

4 · Risks and Limitations

• Technical issues — interruptions, poor connection quality, dropped calls, or platform outages may occur. Dr. Wong or the patient may end the visit if connection quality is inadequate.
• Privacy — internet and telephone communications can be intercepted or accessed without authorization despite reasonable safeguards. Dr. Wong uses a HIPAA-compliant platform but cannot guarantee absolute privacy.
• Limits of remote evaluation — some clinical findings cannot be fully assessed without an in-person examination. Dr. Wong may at any time recommend that an issue be addressed in person or referred to another provider.
• Coordination of care — laboratory testing, vital signs, in-person examinations, and emergency interventions cannot be performed by telehealth and may require referral.

5 · Emergency Procedures

Telehealth is not appropriate for medical emergencies. If I am experiencing a psychiatric or medical emergency — including thoughts of harming myself or others — I will call 911 or go to the nearest emergency room. I understand that Dr. Wong cannot dispatch emergency services and that, in an emergency during a telehealth visit, Dr. Wong may contact 911 or my designated emergency contact and direct services to my last-known location.

I agree to provide an emergency contact (name, relationship, and phone number) and to keep that information current.

6 · Recording

Dr. Wong does not routinely record sessions. Recording — by either party — is not permitted without the prior written consent of the other party, consistent with California Penal Code §632 (two-party consent). On occasion, recording may be conducted for the patient's benefit if the patient chooses (for example, to review portions of a session afterward); separate written consent will be obtained at that time, and you may decline without affecting your care.

7 · Privacy of Your Setting

I am responsible for ensuring that my own physical location during a telehealth visit is private. I will not connect from a public space where others can overhear, and I will use headphones if other people are present nearby.

8 · Right to Withdraw Consent

I may withdraw my consent to telehealth at any time, in writing, without affecting my right to future in-person care.

9 · Financial Responsibility

Telehealth services are billed at the same out-of-pocket fee schedule as in-person services. I understand that some commercial insurers and government payers may not reimburse telehealth, and I accept full responsibility for payment.

10 · Electronic Signature

By typing my full legal name and clicking "Submit Consent," I am providing my electronic signature with the same legal force and effect as a handwritten signature, in accordance with the federal E-SIGN Act (15 U.S.C. §7001 et seq.) and the California Uniform Electronic Transactions Act (Cal. Civ. Code §1633.1 et seq.).