TELEHEALTH INFORMED CONSENT

California + Texas | Dr. Marios Michael, DC

 

Effective Date:  1/1/2020 Last Updated:  1/20/2026

 

This Telehealth Informed Consent (“Consent”) explains telehealth, its benefits and risks, and your rights and responsibilities.

This Consent is governed by and subject to the Terms of Use.


1. WHAT TELEHEALTH IS

Telehealth is the use of electronic communications (such as secure video or phone) to provide healthcare-related services when you and the provider are not in the same physical location.

Telehealth may include:

  • video consultations
  • audio consultations
  • secure messaging or electronic exchange of information
  • review of information you provide (including lab and genetics data)


2. LICENSURE DISCLOSURE (CA + TX)

Dr. Marios Michael, DC is licensed as a Doctor of Chiropractic in: • California

• Texas

Telehealth services are provided only when lawful, based on your physical location at the time of service  and the Provider’s licensure/authorization.


3. PATIENT PHYSICAL LOCATION REQUIREMENT (NON-NEGOTIABLE)

Telehealth is legally tied to your physical location during the session. By proceeding, you represent and agree that:

  • You will disclose your current physical location at the time of each session.
  • You understand that services will be provided only if you are physically located in California or Texas, or another
  • jurisdiction where Provider is legally permitted to practice at that time.
  • Provider may refuse, reschedule, or terminate a session if your location cannot be confirmed or services cannot lawfully be provided.


4. WHAT SERVICES MAY BE PROVIDED VIA TELEHEALTH

Telehealth services may include:

  • functional medicine–style wellness consultations (systems-based guidance)
  • lifestyle and nutritional guidance
  •   review of self-reported health history
  • review of the laboratory findings you provide
  • genomics interpretation and education (when applicable)
  • Telehealth services are not:
  • emergency services
  • in-person physical examination
  • a guarantee of diagnosis or outcome
  • prescription medication management (unless explicitly and lawfully offered under a separate written agreement)


5. BENEFITS OF TELEHEALTH

Potential benefits include:

  • improved access to services
  • reduced travel time and scheduling burden
  • convenience and continuity of care
  • ability to share certain information electronically


6. RISKS AND LIMITATIONS OF TELEHEALTH

Potential risks include:

  • technology failures, interruptions, or poor connections
  • privacy risks inherent to electronic communications
  • limitations due to a lack of in-person physical examination
  • incomplete or inaccurate information due to reliance on self-report
  • You understand telehealth may not be appropriate for all conditions.


7. ALTERNATIVES

Alternatives include:

  • in-person evaluation with Provider (if available and appropriate)
  • in-person evaluation with another licensed provider of your choosing
  • urgent care or emergency services when needed


8. PRIVACY AND ELECTRONIC COMMUNICATIONS

Provider uses reasonable safeguards to protect information. However:

  • no system is 100% secure
  • you are responsible for using a private environment when possible
  • you should avoid public Wi-Fi and shared devices when discussing sensitive matters


9. EMERGENCIES AND URGENT ISSUES  Telehealth is not for emergencies.

  If you are experiencing an emergency:

  • Call 911, or
  • Go to the nearest emergency room
  • The Website and telehealth communications may not be monitored continuously.


10. CONSENT TO TELEHEALTH

By proceeding, you acknowledge that:

• you understand what telehealth is
• you understand the benefits, risks, and limitations
• you understand alternatives
• you consent to receive services via telehealth when appropriate and lawful


11. COMMUNICATION EXPECTATIONS

Provider will inform you of:


If a the platform used how to communicate for scheduling/admin issues what to do if technology fails

session is interrupted, Provider may attempt:

reconnection switching to phone rescheduling if necessary


12. ESTABLISHMENT OF CLINICAL RELATIONSHIP

This Consent alone does not guarantee acceptance as a patient. A doctor–patient relationship is established only under the conditions stated in the Terms of Use  and after the Provider affirmatively accepts you as a patient.