Telehealth

Telehealth Informed Consent and Agreement

Effective date: May 6, 2026 · Last updated: May 6, 2026

1. What Telehealth Is

Under California Business and Professions Code §2290.5(a)(6), telehealth means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. At Pasadena Clinical Group, telehealth means real-time, two-way audio and video psychotherapy delivered through a HIPAA-compliant platform, or, when clinically appropriate and you consent, a telephone-only session.

2. Informed Consent (Bus. & Prof. Code §2290.5(b))

Before delivering health care via telehealth, California law requires us to inform you about the use of telehealth and to obtain your verbal or written consent. By signing this agreement (electronically through the patient portal or in person at the start of telehealth services), you acknowledge that:

  1. You have been informed about the use of telehealth.
  2. You consent to the use of telehealth in your care.
  3. You understand that you may withhold or withdraw consent at any time without affecting your right to future care or treatment, or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.
  4. You have a right to ask questions and to receive answers in language you understand.
  5. You may request that a licensed clinician deliver your care in person rather than by telehealth, and we will accommodate that request whenever clinically appropriate at our Pasadena office.

3. Benefits and Limitations of Telehealth

Benefits. Telehealth allows you to receive care from a familiar location, removes travel time and transportation barriers, and is particularly helpful for clients with mobility limitations, caregiving responsibilities, or chronic illness. For most clients seeking outpatient psychotherapy, the clinical evidence supports parity with in-person care.

Limitations. Telehealth has inherent limitations. The clinician cannot perform a physical assessment, may have a more limited view of nonverbal information, and depends on stable internet or telephone service. Technical problems can interrupt or end a session. Some conditions, levels of acuity, or moments in care are better served in person, and your clinician will tell you if that becomes the case.

4. Telehealth Is Not for Emergencies

If you are in a crisis, please call or text 988 (the 988 Suicide & Crisis Lifeline) or call 911 immediately. Pasadena Clinical Group does not provide emergency services and does not monitor messages or video sessions outside of scheduled appointment times. At the start of each telehealth session, your clinician will confirm your physical location and an emergency contact, so that, if necessary, we can direct help to you.

5. Where You Must Be Located

Our clinicians are licensed in the State of California. Under principles of interjurisdictional licensure, you must be physically present in the State of California at the time of each telehealth session. You agree to inform your clinician at the beginning of each session of your physical location and to update us if you plan to travel. We cannot provide telehealth services to you while you are physically located outside of California, except as expressly permitted under a recognized interstate compact, regulatory exception, or written authorization from the relevant state board.

6. Platform, Privacy, and Security

We use a video and messaging platform vendor that has signed a HIPAA Business Associate Agreement with Pasadena Clinical Group and that supports end-to-end encryption of session content in transit. Despite these protections, no online platform is perfectly secure. You can help us protect your information by joining sessions from a private space, using a secured Wi-Fi connection rather than a public network, ensuring that other applications that record your screen or audio (such as virtual assistants) are turned off, and using a personal device whenever possible rather than a work-issued one.

7. Recording — Two-Party Consent

California is a "two-party consent" state under Penal Code §632. Neither you nor your clinician may record any portion of a telehealth session without the prior written, informed consent of all parties. Pasadena Clinical Group does not record sessions. We make session notes consistent with our regular practice; psychotherapy notes are kept separately as described in our Notice of Privacy Practices.

8. Equipment, Internet, and Environment

  • A computer, tablet, or smartphone with a working camera, microphone, and speaker (or headphones).
  • A reliable internet connection. We recommend at least 5 Mbps download / 3 Mbps upload.
  • A private, well-lit space where the session will not be overheard.
  • A working telephone within reach, in case the video connection fails. Your clinician will call your registered telephone number to complete the session by phone or to reschedule.

9. Availability

Telehealth is available seven (7) days a week, by appointment, within our regular hours: Monday through Friday, 8 AM to 8 PM Pacific; Saturday and Sunday, 8 AM to 4 PM Pacific.

10. Fees, Insurance, and Cancellations

Our fees for telehealth are the same as for in-person care. Most California health plans cover telehealth on parity with in-person services under California Health and Safety Code §1374.13 and Insurance Code §10123.13, but coverage varies; we will verify your benefits before your first session. Cancellation, no-show, and lateness terms are set forth in our Office Policies.

11. Termination and Transition to In-Person Care

Either you or your clinician may, at any time, decide that telehealth is no longer the most appropriate format. We will discuss the reason and either transition you to in-person care at our Pasadena office or, if appropriate, refer you to a different level of care.

12. Assumption of Technology Risk

You understand and accept that telehealth depends on third-party technology (internet service, mobile carrier networks, video and messaging platforms, electrical service, and your own device hardware and software) over which Pasadena Clinical Group has no control. Although we use a HIPAA-compliant platform under a Business Associate Agreement, no online platform is perfectly secure, and interruption, dropped sessions, latency, audio or video quality, and privacy of the room from which you join are factors you accept when you choose telehealth. Pasadena Clinical Group, its owner(s), clinicians, employees, contractors, supervisors, supervisees, and agents (collectively, the "Practice Parties") are not liable for any service degradation, interruption, security incident, unauthorized interception, or breach caused by a third-party platform, carrier, internet provider, electrical utility, or your own device or environment, except to the extent caused by a Practice Party's gross negligence or willful misconduct or to the extent that liability cannot lawfully be limited.

13. Indemnification by Client

To the maximum extent permitted by California law, you agree to indemnify, defend, and hold harmless the Practice Parties from and against any third-party claim, demand, action, loss, liability, damage, cost, or expense (including reasonable attorneys' fees and costs) arising out of or related to: (a) your unauthorized recording, photography, or live-streaming of any session in violation of California Penal Code §632, Civil Code §1708.85, or this Agreement; (b) your willful misconduct, fraud, or material misrepresentation about your physical location, identity, age, or capacity to consent; (c) damage caused by your device or network to Pasadena Clinical Group's systems or those of its vendors; or (d) your violation of this Agreement or applicable law. This indemnity does not apply to any claim arising out of professional negligence by a Practice Party (governed by the Arbitration Agreement at treatment-consent.html) or to any obligation that cannot lawfully be shifted to a patient.

14. Limitation of Liability for Non-Clinical Telehealth Matters

To the maximum extent permitted by California law, the Practice Parties shall not be liable for indirect, incidental, special, consequential, exemplary, or punitive damages arising out of or related to telehealth-platform interruption, connectivity, or third-party vendor failure. Where liability cannot lawfully be excluded, the Practice Parties' aggregate liability for any non-clinical telehealth claim is limited to the fees actually paid by you to Pasadena Clinical Group in the twelve (12) months preceding the event. Nothing in this Section 14 limits any right or remedy that cannot be waived under California Civil Code §1668 or applies to professional-negligence claims (which are governed by the Arbitration Agreement).

15. Mediation, Then Binding Arbitration — Incorporated by Reference

Any dispute, claim, or controversy between you and any Practice Party arising out of or relating to telehealth services, this Agreement, or the business or care relationship — including any claim of medical malpractice or professional negligence — is subject to the Mediation, Then Binding Arbitration Agreement set forth in Sections 15–18 of the Treatment Consent, which is incorporated by reference into this Agreement. The Federal Arbitration Act (9 U.S.C. §§1 et seq.) and, where applicable, California Code of Civil Procedure §1295 govern that arbitration. Government-filing carve-outs, the class action waiver, the confidentiality provision, and the thirty-day right of rescission likewise apply.

16. Governing Law, Venue, and Severability

This Agreement is governed by California law without regard to conflict-of-laws principles, except that the Federal Arbitration Act governs the Arbitration Agreement. For any matter not subject to arbitration, the parties consent to the exclusive jurisdiction and venue of the state and federal courts located in Los Angeles County, California. If any provision of this Agreement is held invalid or unenforceable, that provision will be limited or severed to the minimum extent necessary, and the remaining provisions will continue in full force.

17. Acknowledgment

By signing below (electronically through the patient portal or in person), you confirm that you have read this Agreement, that you have had an opportunity to ask questions, that your questions have been answered to your satisfaction, that you understand and accept the technology risks of telehealth, and that you consent to receiving telehealth services from Pasadena Clinical Group on these terms.

_____________________________________________    Date: ____________
Client signature

_____________________________________________    Date: ____________
Clinician signature

Contact

Pasadena Clinical Group, 301 N. Lake Ave, STE 600, Pasadena, CA 91101 · (626) 354-6440 · office@pasadenaclinicalgroup.com