Medical Practice Privacy and Telehealth Consent Form

Medical Practice Privacy and Telehealth Consent

Medical Privacy

Highgate Heath will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

  • we are obliged by law to disclose your information regardless of consent or otherwise.
  • it is unreasonable or impracticable to gain consent or consent has been refused; and
  • the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.

Telehealth Informed Consent

What is Telepractice?

Telepractice is the use of telecommunication to provide services to clients. The practitioner typically uses videoconferencing to administer client sessions in real-time but may utilise other formats, such as email, for related communication. Telepractice is sometimes referred to as telehealth, telerehabilitation, or telespeech.

What does a telepractice consultation involve?

  • A telepractice consultation usually involves some or all of the following:
  • Your practitioner will discuss your health and your health history with you and, where appropriate, will offer information and advice.
  • You may bring a support person with you, as you might in a face-to-face consultation.
  • If you attend a health service to participate in a telepractice consultation, other health professionals may be present and may need to examine you according to your practitioner’s instructions.
  • A technical support person might be present for part of the consultation to assist with technical issues.
  • You are not permitted to video or audio record the consultation unless your practitioner gives you permission to do so.



What are the potential benefits of telepractice?

Telepractice might:

  • Improve access to services.
  • Reduce your need for travel.
  • Decrease exposure to infectious disease.

What are the potential risks of telepractice?

Telepractice might:

  • Be negatively impacted by technical problems, such as delays due to technology failures.
  • Not offer the same visual and sound quality for observations and modelling
  • Require someone onsite with you to support the practitioner.
  • Not feel the same as an onsite session
  • Not achieve everything that is required and therefore require another telepractice consultation or a face-to-face consultation.
  • Include practices and procedures that are not as well understood in a telepractice setting as they are onsite.
  • Increase exposure to privacy and digital security risks. (See next section.)

Will my privacy be protected?

This practice is subject to the Privacy Act 1988 and must comply with obligations related to the collection, use and disclosure of personal information, including through telepractice. The practitioner must maintain confidentiality and privacy standards during sessions, and in creating, keeping, and transmitting records. 

At times, audio and video recordings of sessions may be taken to support the practitioner’s work, as might occur in a face-to-face consultation. You will be informed before a recording takes place and can refuse to be recorded for any reason. The practitioner will inform you of the reason for the recording and how it will be stored.

While the practitioner is obligated to meet standards to protect your privacy and security, telecommunication, including videoconference, may increase exposure to hacking and other online risks; as with all online activities, there is no guarantee of complete privacy and security protection. You may decrease the risk by using a secure internet connection, meeting with the practitioner from a private location, and only communicating using secure channels.

What does informed consent mean?

There are a few important principles related to informed consent:

  • You must be given relevant information. Ask the practitioner if you have questions about telepractice and the services offered.
  • You have the right to understand the information. Ask the practitioner if you do not understand.
  • You have the right to choose. If you do not agree to telepractice, you may refuse to participate. You may agree to or refuse specific activities and procedures.
  • You have the right to stop using telepractice at anytime. You can change your mind about telepractice or a specific activity or procedure, even in the middle of a session.
  • You can agree or refuse in writing or verbally. You may give your consent using the form below. You may also give consent or change your mind by telling the practitioner. Consent and refusal that you give verbally will be documented by the practitioner.
  • You can ask about alternatives to telepractice. If you refuse or change your mind about telepractice services, your practitioner will discuss any other options with you.  The practitioner may or may not be able to offer alternative services. 


I hereby acknowledge the following.


-I am aware of my right to access my personal information 

-I am aware of my right to withdraw my consent at any time. 

-I understand that my provider must comply with relevant privacy laws, and I will contact the organisation immediately if I feel that these laws have been breached. 

-I understand why certain information about me may need to be provided to other service providers to coordinate the best support for me 

– I agree to receive services via telepractice. 

– I understand that I may agree or refuse any service or part of a service at any time.

– I can agree or refuse in writing or verbally.