Before we conduct a video visit, we need you to understand and consent to the following:

• The video visit will enable me to see and hear my health care providers, and they will see and hear me, in real time.
• Because of my specific medical condition, or due to technical problems, an in-person visit may still be necessary.
• I am responsible for choosing a location that protects my privacy.
• Video visits are not recorded or stored.
• I have had the alternatives to a video visit explained to me and am voluntarily choosing to participate in such a visit. I may at any time request an in-person appointment.