Telehealth Agreement

1. Purpose

This Telehealth Agreement supplements the Treatment Consent and the Notice of Privacy Practices for patients of Pasadena Clinical Group ("PCG") who choose to receive clinical services by telehealth. It is intended to comply with California Business & Professions Code §2290.5, the federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), and applicable rules of the California Board of Psychology and the California Board of Behavioral Sciences. The website itself is informational only and is not a vehicle for telehealth services or self-diagnosis. No clinician-patient relationship is created until you complete intake, sign this Agreement and the Treatment Consent, and attend your first session.

2. Definition of telehealth

Per California Business & 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." Telehealth is a method of service delivery, not a separate type of service; the standard of care that governs in-person services applies equally to telehealth.

3. Informed consent

Before your first telehealth session, you will be asked to consent to telehealth in writing or electronically. Consent includes a discussion of: (a) the nature of telehealth and how it differs from in-person care; (b) the technology used and its limitations; (c) your rights, including the right to refuse telehealth without affecting your ability to receive in-person care (subject to scheduling availability and clinical appropriateness); (d) confidentiality, security measures, and the inherent risks of electronic communications; (e) procedures for technology failure and clinical emergencies; (f) the identity, location, license number, and credentials of the rendering clinician; and (g) information about how to file a complaint with the relevant licensing board.

4. Geographic and licensure limitations

You must be physically located in the State of California at the time of every telehealth session. PCG clinicians are licensed in California and are not authorized to deliver clinical services to patients located in any other state, territory, country, U.S. military base, embassy, or international waters at the time of service. If you anticipate travel outside California, notify PCG in advance; sessions during such travel will be paused, rescheduled, or, where lawful, replaced with non-clinical contact (e.g., scheduling). Misrepresentation of your physical location at the time of service is a material breach of this Agreement and may result in termination of services and reporting to relevant authorities where required by law.

5. Technology requirements; your responsibilities

• A reliable, sufficient-speed internet connection.
• A device with a working camera, microphone, and speaker, and a current operating system and browser.
• Use of PCG's HIPAA-secure video platform; you may not record sessions or use unsanctioned video tools.
• A private, well-lit location where you cannot be overheard. You are responsible for maintaining the privacy of your environment, including ensuring that other persons (including roommates, partners, family, or co-workers) cannot overhear or observe the session.
• You may not attend sessions while operating a vehicle or heavy machinery.
• You will be sober, awake, and able to participate; sessions may be ended early if these conditions are not met.
• You will provide your physical address at the start of each session and an emergency contact name and number; you will inform your clinician immediately if your location changes during a session.

6. Risks specific to telehealth

• Technology failures (internet outages, audio/video drops, software crashes) may interrupt or terminate a session.
• Despite encryption and other security measures, there is residual risk that electronic communications could be intercepted, recorded by malware on your device, or accessed by other persons in your physical environment.
• Some clinical assessments — for example, observation of subtle non-verbal cues, motor behavior, or medication side effects — are inherently more limited via video.
• Confidentiality may be compromised by your physical environment (e.g., other persons in the home; cohabitants entering the room) or by your device (e.g., shared devices, smart-speakers, screen-sharing software, parental-monitoring software).
• Telehealth may not be clinically appropriate for all conditions or stages of treatment; your clinician will discuss alternatives if telehealth is not the right fit.

7. Confidentiality and limits — same as in-person care

The confidentiality limits described in the Treatment Consent and Notice of Privacy Practices apply equally to telehealth, including mandated reporting (Cal. Penal Code §11164 et seq.; Cal. Welf. & Inst. Code §15630), Tarasoff duties (Cal. Civ. Code §43.92), the duty to act on imminent danger (including initiating Welf. & Inst. Code §5150 evaluation when warranted), responses to court orders and qualifying subpoenas, and disclosures to mandated regulators or auditors. Heightened protections under 42 C.F.R. Part 2, CMIA, HIV/AIDS confidentiality (Cal. Health & Safety Code §120975 et seq.), and other applicable laws apply.

8. Emergencies and crisis-response protocol

Telehealth is not appropriate for emergencies. If you are in immediate danger or experiencing a psychiatric or medical emergency, call or text 988, call 911, or proceed to the nearest emergency department. At the start of every telehealth session, your clinician will confirm your physical address and emergency contact so emergency services can be directed if needed. If your clinician determines a higher level of care is necessary, your clinician may, with or without your consent as permitted by law, contact emergency services, your emergency contact, or appropriate authorities.

9. Recording prohibited

Sessions may not be recorded — by audio, video, screenshot, screen capture, transcription tool, voice assistant, AI assistant, or otherwise — by either party without the express written consent of the other. Unauthorized recording violates California Penal Code §632 and is a material breach of this Agreement that may result in immediate termination of services and possible legal action.

10. Identity verification

Your clinician will verify your identity at intake and may ask for periodic re-verification. You will not allow another person to attend a session in your place or impersonate you. Attendance by another person (e.g., a partner, parent, interpreter, or attorney) requires advance discussion and clinical appropriateness; an authorization or release may be required.

11. Insurance and reimbursement

Telehealth services are typically reimbursed by California-regulated insurance plans on parity with in-person services per California Health & Safety Code §1374.13 and California Insurance Code §10123.13. Federally regulated plans (ERISA, Medicare) follow their own rules. Your insurance card and policy control. PCG does not warrant any specific level of reimbursement; coverage and patient responsibility are between you and your insurer.

12. Continuity of care; right to refuse telehealth

You may decline telehealth at any time and request in-person services, subject to clinician availability and clinical appropriateness. If telehealth is determined to be clinically inappropriate, your clinician will work with you on a transition plan, including referrals where appropriate.

13. Out-of-state travel; cross-jurisdictional issues

Should you travel outside California, the receipt of clinical services may be unlawful in your then-current jurisdiction. PCG will not knowingly provide clinical services across state lines. PCG is not liable for any loss or harm arising from your misrepresentation of your physical location.

14. Special protections for minors

Minors who consent to their own outpatient mental-health services under Cal. Family Code §6924 must be in California at the time of every session. PCG primarily serves adults; minor referrals are evaluated case-by-case, and additional documentation (parental consent where applicable, school address verification) may be required.

15. Records

Telehealth records are maintained on the same retention schedule as in-person records (Cal. Health & Safety Code §123145).

16. Limitation of liability; dispute resolution

Limitations of liability and dispute-resolution provisions in the Treatment Consent (including mandatory pre-suit notice, mediation, and binding arbitration under California Code of Civil Procedure §1295) apply to any claim arising out of or relating to telehealth services rendered by PCG. The website-related terms — including arbitration of website-related disputes, class-action and representative-action waivers, jury-trial waivers, governing-law and forum-selection clauses, and shortened limitations period — are set forth in the Terms & Conditions and apply to website use, marketing, and prospective-client interactions.

17. Filing a complaint

You may file a complaint about a clinician's conduct with the appropriate California licensing board: California Board of Psychology (psychologists); California Board of Behavioral Sciences (LMFTs, LCSWs, LPCCs); or the Medical Board of California.

18. Changes to this Agreement

PCG may update this Agreement to reflect changes in law, technology, or operations. Material updates will be communicated to current patients. The latest version is posted on the Site.

19. Contact

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