(626) 354-6440 office@pasadenaclinicalgroup.com Հեռաբուժությունը հասանելի է շաբաթվա 7 օր
Ծառայություն 8 լեզուներով
Pasadena Clinical Group Ամբուլատոր հոգեկան առողջություն · Լոս Անջելես
Իրավական և գաղտնիություն

Telehealth Agreement

⚠ Template content — must be reviewed and finalized by the practice's California-licensed attorney and compliance officer before publication. This document is a working draft modeled on California-specific legal requirements as of the date below. It does not constitute legal advice and may require modification for the practice's specific operations.
Effective date: 2026-04-29 Last updated: 2026-04-29 Contact for questions: office@pasadenaclinicalgroup.com · 301 N. Lake Ave, STE 600, Pasadena, CA 91101

This Telehealth Agreement supplements your Treatment Consent and applies whenever any portion of your services with Pasadena Clinical Group is delivered via telehealth (video, audio, or secure messaging). It is provided in compliance with California Business & Professions Code §2290.5 ("Telehealth").

1. Definition of telehealth

Telehealth means the delivery of healthcare services using information and communication technologies between a clinician at one site and a client at a separate site. Synchronous video sessions are our primary modality; brief synchronous audio (phone) and asynchronous secure messaging may be used in limited circumstances at clinician discretion.

2. Informed consent

Before your first telehealth encounter, your clinician will obtain your informed consent for telehealth services. You have the right to refuse telehealth at any time and request in-person services instead, subject to clinical appropriateness and our scheduling availability.

3. Geographic limitation

Our clinicians are licensed in the State of California. You must be physically located in California at the time of the session. If you anticipate traveling out of state, please notify your clinician in advance — we may not be able to provide care during that period due to interjurisdictional licensure rules.

4. Technology and security

We use HIPAA-compliant video platforms with end-to-end encryption. To protect your privacy:

  • Use a private, quiet space where you cannot be overheard.
  • Use a secure internet connection (avoid public Wi-Fi).
  • Do not record sessions without your clinician's explicit written consent — recording is otherwise prohibited.
  • Keep your device updated and password-protected.

5. Limitations of telehealth

Telehealth has limitations relative to in-person care:

  • Non-verbal communication is partially obscured by the medium.
  • Technical issues (connection quality, audio dropouts) may interrupt sessions.
  • Telehealth is not appropriate for emergencies. If you are in crisis, do not contact us via telehealth — call 988 (Suicide & Crisis Lifeline) or 911, or go to your nearest emergency department.

6. Continuity of care

If a session is interrupted by technical difficulty, your clinician will attempt to reconnect by phone within 5 minutes. If reconnection is not possible, the session will be rescheduled at no charge.

7. Backup contact information

For safety, we ask that you provide an emergency contact and your physical address at the start of each session in case of crisis or technology failure. This information is used solely for safety purposes.

8. Seven-day-a-week availability

Telehealth sessions are scheduled across our full operating hours: Monday–Friday 8:00 AM – 8:00 PM and Saturday–Sunday 8:00 AM – 4:00 PM. We are not available outside these hours. For after-hours emergencies, please call 988 or 911.

9. Recording and intellectual property

Sessions may not be recorded (audio or video) by either party without the other's explicit, written, advance consent. This protects the confidentiality and clinical integrity of the work.

10. Acknowledgment

By participating in telehealth services with Pasadena Clinical Group, you acknowledge that you have read this Agreement, understand its terms, and consent to telehealth as a method of receiving care.