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Telehealth Online Form Example

Telehealth Online Form ExampleAlexei Kouleshov2020-06-01T16:33:06+10:00
Your Easy Web Solutions
Your Easy Web Solutions

P: 07 3117 2568

F: 03 9018 9486

E: info@yews.com.au

604 Stanley St, Woolloongabba QLD 4102

Telehealth Consultations

Your Easy Web Solutions offers Telehealth services to patients who are otherwise unable or have difficulties attending their appointment in clinic due to chronic health conditions or increased travel distance.

The benefits of having a video consultation can be:

  • Reducing the waiting time to see a specialist

  • Avoiding your need to travel to the specialist

  • Reducing the risk of contracting community transmitted illnesses (e.g. COVID-19)

The risks of having a video consultation can be:

  • A video consultation will not be exactly the same, and may not be as complete as a face-to-face service.
  • There could be some technical problems that affect the video visit.
  • This health care service uses systems that meet recommended standards to protect the privacy and security of the video visits. However, the service cannot guarantee total protection against hacking or tapping into the video visit by outsiders. This risk is small, but it does exist.

The following platforms can be used for Telehealth Consultations. Please have your phone with you at the time of the appointment in case of technical difficulties.

Skype

  • Skype can be used on your computer/laptop, tablet or smart phone.
  • Ensure Skype is installed on your device (Skype Download)
  • If you don’t already have a Skype account you will need to create one (Create Account)
  • Test your audio and video through the initial Skype setup process

  • Be in a quiet room free from distractions

  • Advise us of your Skype ID or email address so that we can find you

  • Your specialist will call you at the appointment time. If there is a delay, we will attempt to notify you via phone

  • Skype help directory – https://support.skype.com/en/skype/

Phone

  • Be in a quiet room free from distractions
  • Your specialist will call your preferred contact number at the time of your appointment

Fees

Most of our patients are eligible to receive bulk billed Telehealth consultations. We will advise you if you are not able to be bulk billed. In this case regular consultation fees will apply.

Consent

We require your written consent to go ahead with Telehealth Consultations. You are still able to attend a faceto-face consultation with your specialist if considered reasonable and safe for both patient and specialist. A telehealth video consultation will only happen if your specialist considers it safe and suitable and you are happy to participate in a telehealth video consultation.

Please complete the consent form on the next page if you wish to partake in Telehealth Consultations.

Telehealth Consent Form

Telehealth uses audio and video technology to connect you to your Specialist. This reduces the need for you to travel long distances and provides you timely access to the specialist service.

Please ensure you are fully informed and satisfied with this approach before signing this Consent Form.

  • Date Format: MM slash DD slash YYYY
  • In addition, I understand and agree that:

    • Participation in a Telehealth clinical consultation is voluntary and I have the option of a face- toface consultation if deemed reasonable and safe by my specialist.
    • I have the right to withdraw my consent at any time.
    • I have the right to cease consultations at any stage.
    • Your rights to confidentiality and privacy will be respected.
    • There will NOT be any audio or video recording or photographing of the session by Your Easy Web Solutions services and we do NOT accept any such recording or photographing by you or any other persons involved.
    • Your specialist will take notes during the consultation.
    • I agree to the information discussed in the Telehealth Consultation to be discussed with other practitioners involved in my care.
    • This consent relates to an ongoing period of care as required
    • I consent to this practice claiming the benefit amount for this service from Medicare

    By signing this form, you acknowledge that you have read and understood (or have been explained) the information in this form and that you give consent to participate in Telehealth Consultations.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.

Contact Information

BRISBANE OFFICE
  1/604 Stanley St, Woolloongabba QLD 4102
  Phone: 07 3117 2568

MELBOURNE OFFICE
  Office 20 / 15 Cochranes Rd, Moorabbin VIC 3189
 Phone: 03 9018 9486

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About Us

We are an Australian based company with offices in Brisbane and Melbourne. We have worked with some of Australia’s leading marketers in helping them implement their project through our technical experience. [Read More]

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