Policy and consent
Telehealth Consent
This document explains the terms of receiving telehealth services through Glova. Please review each section carefully before proceeding with intake, treatment, or follow-up care.
Important: Telehealth is not appropriate for emergency conditions. If you believe you are experiencing a medical emergency, call 911 immediately.
1) Telehealth Services and Scope
- I understand Glova provides virtual care services and not emergency medical care.
- I understand clinicians may determine that in-person evaluation, urgent care, or emergency services are required.
- I understand treatment availability and prescribing decisions depend on clinical appropriateness and applicable law.
2) Consent to Virtual Communication
- I consent to communicate with my care team through secure messaging, video, phone, and electronic forms.
- I understand response times may vary and that messaging should not be used for urgent or life-threatening symptoms.
- I understand technical interruptions may occur and that alternate methods may be used to continue care.
3) Risks, Benefits, and Alternatives
- I understand potential benefits include convenient access to licensed clinicians and continuity of care.
- I understand potential risks include delays, incomplete information, or limitations from remote assessment.
- I understand alternatives include in-person evaluation with a local provider or clinic.
4) Privacy and Data Use
- I understand my health information is handled in accordance with applicable privacy laws and Glova policies.
- I understand my information may be shared with pharmacies, labs, or partner clinicians as needed for treatment and operations.
- I understand I should use a private setting and secure internet connection when receiving telehealth services.
5) Medications, Follow-Up, and Safety
- I understand medications may have side effects, contraindications, or interactions and may not be appropriate for everyone.
- I agree to provide complete and accurate medical history, medication lists, and symptom updates.
- I agree to seek urgent or emergency care immediately for severe symptoms, and to call 911 when appropriate.
6) Patient Responsibilities and Agreement
- I confirm I am physically located in a jurisdiction where my treating clinician is authorized to provide care.
- I understand I may withdraw this consent at any time, but doing so may limit access to telehealth services.
- By continuing with intake or treatment, I acknowledge that I have read, understood, and consent to this telehealth agreement.