Telehealth Consent

What is Telehealth?

  • Telehealth Services are provided through videoconferencing between you and our healthcare providers on a secure internet connection.
  • You will be able to see and hear our staff, and they will be able to see and hear you.
  • You can receive telehealth service on any device that has internet, email, audio, and video capabilities (examples: home computer, cell phone, or tablet). 

Protecting your Privacy

  • Shepherd Center uses a HIPAA approved video platform to ensure that your communications are secure and private. Sessions will not be recorded by you or our staff, without consent from both parties.
  • Confidentiality still applies for telehealth services. Only authorized individuals may access your information in electronic medical records, which will include documentation of relevant information exchanged via telehealth sessions. However, Protected Health Information (PHI) may be released to other providers without authorization if used for treatment, payment, healthcare operations, or for public health activities or law enforcement purposes as permitted by state and federal laws.
  • There are potential benefits and risks of telehealth services that differ from in-person sessions. For example, someone could access your information without you or Shepherd Center knowing (e.g., if someone hacks into your or Shepherd Center’s computer system or server).  Or others in your home may overhear or observe your communications. We will all do our best to ensure your confidentiality.

What if there are technical problems?

  • Videoconferencing can result in technological difficulties, such as dropped calls, lost or frozen images, lack of sound, or distorted sound.
  • Shepherd Center will work to minimize and address these difficulties. Relevant contact information will be provided to address technical questions and concerns prior to your next telehealth appointment. Responses are limited to standard clinic hours (e.g., M-F from 8 a.m. to 3 p.m.). We will strive to respond within 24 hours.
  • If we experience technical difficulties during a telehealth session and it cannot be resolved in a timely manner, we may call you via telephone to finish the session or to reschedule.

What if I have a physical problem or if there is an emergency?

  • Telehealth services are not on-demand or emergency services.
  • If you think you might be facing an emergency that could result in harm to you or to another person, you are NOT to seek a telehealth consultation.
  • Instead, you should seek care immediately through your own local health care provider, or at the nearest hospital emergency department, or by calling 911.

Billing and Payment Information

  • Your insurance will be billed for telehealth sessions unless you are under a different pay agreement with Shepherd Center.  
  • You may contact Shepherd Center’s Patient Financial Services Department (404-350-7320) with any questions, or contact your insurance provider for more information.


By accepting the terms of this Telehealth Consent:

  • I agree to participate in Telehealth services provided by Shepherd Center.
  • I agree to use the video-conferencing platform identified for our virtual sessions.
  • I understand that my participation is voluntary, and I retain the right to withdraw at any time.
  • I understand that my provider may determine that due to certain circumstances, telehealth is no longer appropriate, and I would be provided referral information if this happens.
  • I understand the potential benefits and risks of video-conferencing and electronic communications, including the need to ensure confidentiality when I participate. 

For minors and/or those with a legal representative, a parent/guardian must present the patient for telehealth services and agree to the terms of this Telehealth Consent unless otherwise exempted by state or federal law. The parent/guardian need not attend the telehealth session unless attendance is therapeutically appropriate.

Download the Telehealth Consent agreement.