By using the HelloDoc Health platform on either HelloDochealth.com, hellodoc.uwzorgonline.nl and other HelloDoc services you consent and agree to the following terms and conditions:

• You understand that the purpose of this consent is to inform you of the risks and benefits of receiving care via telehealth and to provide information on the terms under which telehealth services will be made available to you.
• If you consent to receive telehealth services as described in this terms and conditions document,you acknowledge that you may receive telehealth services from a HelloDoc Health BV  (chamber of commerce 83863697, The Netherlands) employed provider or from an independent private health care provider under contract with but not employed by HelloDoc Health.
• You understand that “telehealth” includes the practice of health care delivery, assessment, diagnosis, consultation, treatment, transfer of medical data, and psychoeducation using interactive audio, video, or data communications between a provider and a patient who are not in the same physical location.
• Telehealth appointments are considered outpatient services and not intended as a substitute for emergency or crisis services. Crisis or mental health emergencies should be addressed by presenting to your nearest hospital or by calling 113 or local emergency crisis prevention services.
• If there is a disruption in technology then you may call +31 85 201 30 73 to talk to a HelloDoc Health provider. You should at all times contact your own healthcare provider.
• The laws and professional standards that apply to in-office services also apply to telehealth services. This document does not replace other agreements, contracts, or documentation of informed consent.
• You understand that you may need to download an application and/or software to receive HelloDoc Health’s telehealth services. You also need to have a broadband internet connection or a smartphone device with a good cellular connection at home or at the location deemed appropriate for services. Any electronic devices you use must be fully charged before the service will be rendered.
• You also understand that in case of technology failure, you may contact a HelloDoc Health provider via phone to coordinate alternative methods of treatment (for instance  home visit).
• You agree to use your own equipment (e.g., computer, video camera) to communicate and not equipment owned by another person. You are solely responsible for security measures and in case there are (successful) attempts to hack your device by other third parties, HelloDoc Health will not be held responsible for security breaches caused in conjunction with security breaches resulting from security failure from your device.
• As a provider of primary care services, HelloDoc Health DOES NOT record telehealth sessions without prior permission. If telehealth sessions are recorded, the digital recording will be shared and stored in accordance with privacy requirements and GDPR regulations. In addition, the telehealth platform(s) utilized for telehealth services will employ security safeguards to protect the privacy and security of health information and imaging data, and will include measures to safeguard the security and integrity of your health information during a session. Telehealth services rely on technology, which allows for greater convenience in service delivery.
• You acknowledge and understand that your private health information may be transmitted from your provider’s mobile or other computing device to your own or from your device to that of your provider via a technology vendor’s application. There are risks in transmitting information using technology that include, but are not limited to, breaches of confidentiality or privacy of personal health information, theft of personal information, disruption of service due to technical difficulties, and risks that the information or communication will be intercepted by an unauthorized person or persons. The use of telehealth is a delivery method in an area that is still being researched that has potential risks which may include some areas that are not yet recognized. Among the risks of telehealth that are presently recognized is the possibility that the technology will fail before or during the consultation, that the transmitted information in any form will be unclear or inadequate for proper use in the consultation(s), and that the information will be intercepted by an unauthorized person or persons. If your provider is concerned about you and there is a lost connection they may call one of your emergency contacts to check on you or may call 112 for a well check.

RIGHTS AND CONSENT TO TELEHEALTH 

• You understand that you have the right to cease treatment at any time.
• You understand that there are risks and consequences associated with telehealth including, but not limited to the risks listed above and the possibility, despite reasonable efforts on the part of your provider, that the transmission of your medical information could be disrupted or distorted by technical failures.
• You understand that telehealth-based services and care may not be as complete as in office (or in person, face-to-face) services.
• You understand that if your provider believes you would be better served by another form of therapeutic services (e.g. in- office or face-to-face services) they can discontinue telehealth therapy sessions with you and you can make an in-office appointment with (another) healthcare provider. However, if that is not possible then you will be referred to a provider who can provide such services in your geographic area. It is your responsibility to contact such providers in your area.
• You recognized that you can find other providers by contacting your insurance.
• You understand that you may benefit from telehealth but that results cannot be guaranteed or assured.
• You understand that you must be physically in the same country or region your provider is licensed in to receive telehealth services. For example, if your provider is licensed in The Netherlands,  then you must physically be present in The Netherlands  to participate in telehealth treatment.
• You understand it is your responsibility to maintain privacy on the patient end of communication.
• You understand that the physical setting you are in during a telehealth session will be private and free from disruptions and will not have other individuals present unless a valid written consent is on file for them to participate in your care.
• You understand the laws and professional standards that apply to in-person behavioral services also apply to telehealth services.
• You understand and consent to participate in technology-based consultation and other healthcare related information exchanges with your provider to receive services via telehealth. This means that you authorize information, data, and communications related to your medical information and mental health to be electronically transmitted, and to be stored incident to such transmission, through an interactive video connection to and from: your provider using a telehealth platform, any third-party technology vendor providing the telehealth platform or application, other persons involved in your health care, and the staff operating the equipment.
• You understand that security protocols utilized in the provision of telehealth could fail, resulting in unauthorized access to or interception of your personal health information.
• You understand that if you are deemed a danger to yourself or others then you will not seek a telehealth session and instead agree to seek care immediately through your own local health care provider or at the nearest hospital emergency department or by calling 113.
• You understand that the exchange of information will not be in person and any paperwork exchanged will likely be provided through electronic means.
• You agree that by opting yes, you are electronically signing this consent for telehealth services or any other forms related to the provision of telehealth that you intend your electronic signature to have the same binding legal effect as your physical written signature.

Insurance

• It is important to evaluate what resources you have available to pay for your treatment. If you have a health insurance policy, it will usually provide some coverage for mental health treatment. However, it is your responsibility to know what your health insurance policy covers and you (not your insurance company) are responsible for full payment of your provider’s fees. This includes telehealth services and lab services.
• Further, your provider is not on every insurance panel, so it is important that you verify the provider’s participation in your network if you will be using your insurance benefits. Ultimately, you are responsible for maintaining coverage through your health insurance. You should also be aware that most insurance companies require you to authorize your provider to provide them with a clinical diagnosis. Sometimes your provider has to provide additional clinical information such as treatment plans, summaries of treatment, copies of an evaluation, or the entire record. By signing this Informed Consent for Treatment you are giving HelloDoc Health consent to provide limited treatment information to your insurance company in case of any claims disputes.

HELLODOC HEALTH FEE POLICY 

• Charges for services are due and payable in full at the time the services are rendered. If you have health insurance coverage, a claim form will be filed on your behalf. In the event the insurance company rejects your claim, the amount paid is based on HelloDoc Health’s fee schedule. You are responsible for paying the balance owed on your account. Your account can be settled using wired bank transfer only. If a statement remains unpaid after sixty (60) days and no satisfactory arrangements have been made, we will pursue collection to the fullest extent permitted by law, which may include the account being sent to collections or small claims court. The cost of any such proceedings will be included in the claim.

APPOINTMENTS 

• Appointments scheduled must be cancelled by at least 4 hours in advance. Work, school and/or social obligations are not considered circumstances beyond your control. Your insurance does not pay for missed sessions. In addition, appointment reminders are a courtesy and it is your responsibility to know the date and time of your appointment.

EMERGENCY CONTACTS 

• You will be asked to provide  names and telephone numbers of your local emergency contacts (including local physician;trusted family, friend, and/or adviser).
• You unconditionally release and discharge HelloDoc Health its affiliates, agents, employees; billing services contractor, its affiliates, agents, and employees; and your provider and his or her designee from any liability in connection with your participation in the telehealth treatment.

ACKNOWLEDGEMENTS

• You understand that your provider will regularly reassess the appropriateness of continuing to deliver services to you through telehealth means and will modify your care plan as needed. This document has explained how telehealth health services are performed and you understand that telehealth sessions will differ from in-person services, including but not limited to emotional reactions that may be prevented or stunted by the use of technology. In addition, some information that could be obtained in an in-office appointment may not be available with a telehealth session.
• You understand that such missing information could make it more difficult for your provider to understand your symptoms or problems and help you get better.
• You also understand that your provider will be unable to physically touch, or to render any emergency assistance if you experience a crisis or acute illness.
• You have read this document carefully and fully understand the benefits and risks.
• You understand the costs associated with your receipt of telehealth services and you agree to pay amounts due on your account.
• You have had the opportunity to ask any questions you have and have received satisfactory answers. With this knowledge, you voluntarily consent to participate in telehealth treatment, including but not limited to any care, treatment, and services deemed necessary and advisable, under the terms described herein.
• You acknowledge that all the information you provide to the health professional is accurate and correct.
• You will not attempt to provide information to the health professional in a way that may affect the nature of the consultation.
• You agree that you do not have an urgent medical condition that would require immediate medical attention.
• You agree that you do not suffer from an oncological disease in which you are receiving or have in the past 3 months received chemotherapy, radiotherapy or a combination of both.
• You agree that the information you provide on the HelloDoc Health platform to the health professional is accurate and pertains to you.
• You agree with the payment and services.
• You agree that you will not hold HelloDoc Health B.V. or its third party services accountable for any unforeseen events occurring during or after the consultation.
• You agree that you are over 16 years of age.
• You agree that you are either registered with a local family GP in the Netherlands, otherwise known as a ‘huisarts’, or that you are actively searching for a local family GP.  In the event that you have not registered with a ‘huisarts’ you agree that HelloDoc Health will perform a yearly GP search for you and may terminate your services if your sole purpose is to seek medical advice only through www.hellodoc.health without being registered or actively looking for a Dutch GP in your area within the Netherlands.
• You understand that each consultation will be a maximum of 20 minutes per consultation.