I hereby consent to engage in telehealth with EZAutism (Odin Technologies FZE). Telehealth is a form of psychological service provided via internet technology, which can include consultation, therapy recommendations, transfer of medical data, emails, telephone conversations and/or education using recorded / interactive audio, video, or data communications. I also understand that telehealth involves the communication of my medical/mental health information, both in writing and/or recorded visually.

Telehealth has the same purpose or intention as psychological diagnosis that is conducted in person. However, due to the nature of the technology used, I understand that telehealth may be experienced somewhat differently than face-to-face sessions.

Benefits of Telehealth.

Reducing the waiting time to see a specialist of other distant service.

Avoiding your need to travel to the specialist or distant service.

Assisting your local health service to better look after you.

I know and understand that I may not get all these benefits.

I understand that I have the following rights with respect to telehealth:

Client’s Rights, Risks, and Responsibilities

I understand that the information disclosed by me during the diagnosis is generally confidential.

I understand that there are risks and consequences of participating in telehealth, including, but not limited to, the possibility, despite best efforts to ensure high encryption and secure technology on the part of my provider, that: the transmission of my information could be disrupted or distorted by technical failures; the transmission of my information could be interrupted or intercepted by unauthorized persons; and/or the electronic storage of my medical information could be accessed by unauthorized persons. There is a risk that services could be disrupted or distorted by unforeseen technical problems. In addition, I understand that telehealth based services and care may not be as complete as face-to-face services.

I understand that I may benefit from telehealth, but that results cannot be guaranteed or assured. I understand that there are potential risks and benefits associated with any form of psychological diagnosis, and that despite my efforts and the efforts of the provider my condition may not improve.

I accept that telehealth does not provide emergency services. If I am experiencing an emergency situation, I understand that I can call the nearest healthcare facility in my area/city/country for help. Clients who are actively at risk of harm to self or others generally are not suitable for telehealth services. If this is the case or becomes the case in future, my provider may, if necessary, recommend that I seek other service more appropriate to my particular circumstances.

I am responsible for (1) providing the necessary computer, telecommunications equipment, and internet access for my telehealth diagnosis, and (2) arranging a location with sufficient lighting and privacy that is free from distractions or intrusions for my telehealth video & audio recordings.

I understand that the telehealth diagnosis information and recorded videos and audios are stored.

I understand that EZAutism TAP EZAutism does not provide telehealth services to patients who are minor under the age of 18.

I understand that consent form covers minors under my guardianship and includes:

My consent on behalf of the patient to receive diagnosis from EZAutism TAP.

My agreement on behalf of the patient to receive services using telehealth technology; and

I certify that I am a person with legal authority to act on behalf of the patient, including the authority to consent to medical services, and accept financial responsibility for services rendered;

I Agree to the terms of this Consent, including the Terms & Conditions and Privacy Notice of the EZAutism TAP Portal.

By signing below, I certify that:

I have read, understand, and agree to the contents of this document, I understand the benefits and risks of engaging in telehealth services, and I consent to engaging in telehealth services with EZAutism.