Informed Consent for Telehealth Services
Last updated: May 1, 2026
By using the Sivo Health platform and receiving telehealth services, you consent to engage in telehealth (e.g., internet or telephone-based medical consultations) with providers affiliated with Sivo Health.
1. Nature of Telehealth
Telehealth involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:
- Patient medical records
- Medical images
- Live two-way audio and video
- Output data from medical devices and sound and video files
2. Expected Benefits
- Improved access to medical care by enabling a patient to remain in their home or office.
- More efficient medical evaluation and management.
- Obtaining expertise of a specialist.
3. Possible Risks
As with any medical procedure, there are potential risks associated with the use of telehealth. These risks include, but may not be limited to:
- In rare cases, information transmitted may not be sufficient (e.g., poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s).
- Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.
- In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
- In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
4. Consent to Telehealth
By proceeding with Sivo Health, I acknowledge that I have read and understand the information provided above regarding telehealth, have discussed it with my physician or such assistants as may be designated, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telehealth in my medical care.
I also understand that I may withdraw my consent to telehealth services at any time, but that this may limit the services my provider is able to deliver via the Sivo Health platform.