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A person uses an index finger on a tablet screen while seated at a white desk with a dual white monitor setup and white keyboard, representing the accessible and secure telehealth services, service options, and methods of submitting administrative forms and acknowledgments available through Availia TeleHelp PLLC in Spokane and Washington State.

Telehealth Consent

Complete before your first telehealth session; covers the technology used, privacy considerations, and your rights as a telehealth client.

Please Note:

This form is required for all clients receiving services via video.

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Complete this form before your first telehealth session or bring it to your appointment.

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If your primary session location changes at any point during your services,

please complete a new form and submit it before your next session.

Availia Client Information:

Date of Birth
Month
Day
Year

About Telehealth Services

Telehealth allows you to receive services remotely via secure video conferencing. Your provider delivers the same quality of care through telehealth as in-person. Availia is not obligated to provide telehealth services and reserves the right to require and/or refer out to in-person attendance when clinically or administratively appropriate. If your services are court-ordered or otherwise mandated, it is your responsibility to confirm with the supervising party whether telehealth attendance satisfies your requirements. Availia cannot guarantee that virtual services will be accepted by any external authority.

Technologies & Limitations

Services are delivered using encrypted video conferencing technology. Even with reasonable safeguards secured, electronic data transmission carries inherent risks that cannot be fully eliminated. In the event of technology failure during service, your provider may continue via audio-only if clinically appropriate and you consent. You may request in-person services at any time. Electronic records are maintained on HIPAA-compliant platforms with secure, limited access and backup provisions.

Your Rights & Responsibilities

You have the right to refuse or withdraw consent for telehealth services at any time without affecting your right to receive in-person care. You are responsible for ensuring a private location during each session and for providing your current physical location at the start of any session conducted from an address other than the one on file with Availia.

Provider Information

Services are provided by:

Duncan True, SUDP, NCACI, NCSE

Administrator, Availia TeleHelp PLLC

316 West Boone Avenue Suite 669

Spokane WA 99201, 509-495-1222.

Client Acknowledgments

Availia TeleHelp PLLC and signee agree that any digital signature may serve the full legal effect and function of a handwritten signature.

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