Agreement to get care by video

You are agreeing to receive health care services in a video visit with one of our clinical providers and consent to these terms of service.
 
You may request an in-person appointment with a clinician if you prefer, and available alternative options have been presented to you. You can change your mind about receiving health care services via telehealth at any time without affecting your right to future care or treatment and without risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. Your video visit clinician might recommend an in-person appointment if they determine that your concern cannot be addressed in a video visit. Your telehealth visit could also be disrupted by technical difficulties outside of your clinician’s control.   
 
If you need to see a clinician in person following the telehealth consultation or if an urgent need arises, you can make an appointment through kp.org or by calling the appointment telephone number on your membership card. You can also find information about urgent care options on our website. 
 
Information about this visit will be documented by your clinician in your medical record and will be available to your other Kaiser Permanente treating clinicians. The visit record will be accessible to you and maintained confidentially according to Kaiser Permanente privacy policies. Kaiser Permanente has taken steps to encrypt and otherwise protect the information you share during your visit. You have the right to be informed of all participants in your video visit. 
 
Some, but not all, plans cover telehealth at zero cost-sharing. The amount you will pay for services depends on what your copay or coinsurance is, whether you have a deductible, and other plan limitations, consistent with the terms of your Evidence of Coverage or other coverage documents, and will be calculated based on the treating provider’s billed charges.
 
Video or audio recording of this visit is not permitted without the express agreement of your clinician.