TOLTA TELEHEALTH — LEGAL & POLICIES
Tolta Telehealth – Telehealth Legal Notices & Patient Disclosures (New York State) By booking an appointment with Tolta Telehealth, you agree and consent to all terms, policies, and disclosures outlined below. Tolta Telehealth provides virtual clinical services to patients located within New York State only. 1. Eligibility & Location Requirement Telehealth services are available only to patients physically located in New York State at the time of the visit. Your location may be verified through your ID, intake forms, or verbal confirmation. You must confirm your physical location at each consultation. 2. Treatment of Minors Patients under 18 require consent from a parent or legal guardian. A parent/guardian may be asked to join at the beginning for identity and consent verification. NY-permitted confidential adolescent services may be provided when allowed by law. 3. Establishing the Patient–Provider Relationship A provider–patient relationship is formed when: You provide accurate intake and medical history information, Your provider reviews this information, and A telehealth visit begins with your consent. This includes assessment, diagnosis (when appropriate), treatment planning, and follow-up guidance. 4. Medical History & Intake Information You agree to provide complete and accurate medical history, medications, allergies, and symptoms. Telehealth evaluations rely on your reported information, which may impact diagnosis or treatment. 5. Limits of Virtual Care Telehealth has inherent limitations, including: Lack of hands-on physical examination Inability to assess certain symptoms visually or physically Technology or connection limitations If your condition cannot be safely addressed through telehealth, you will be advised to seek additional care. 6. Emergency Care Notice Tolta Telehealth does not provide emergency services. If you experience a medical or mental health emergency, call 911 or go to the nearest emergency room immediately. 7. Privacy, Confidentiality & Security Your health information is protected under HIPAA and NY State confidentiality laws. Virtual visits occur through secure, encrypted platforms. You are responsible for choosing a private location during your visit. 8. Informed Consent for Telehealth By booking and completing a telehealth visit, you consent to: Receiving care via video or electronic communication, The use of electronic prescriptions when clinically appropriate, Sharing information with pharmacies, labs, or other care partners as needed, Understanding the limitations of remote care. You may withdraw telehealth consent at any time. 9. Prescriptions & Medication Policy Medications are prescribed only when clinically appropriate. No narcotics or controlled substances are prescribed. Additional documentation or labs may be requested for medication safety. 10. No Insurance Accepted Tolta Telehealth is a self-pay practice. Payment is due at the time of service. A superbill can be provided for possible out-of-network reimbursement. 11. Contact Information For non-urgent questions or administrative support, contact us through the website form or patient portal. Clinical advice cannot be provided by email.
