Telehealth Services Agreement
Informed consent and terms for remote mental health services. Effective May 1, 2026. Last updated May 1, 2026.
Telehealth Agreement Sections
1. Definition of Telehealth
Under California Business and Professions Code § 2290.5, telehealth is defined as the mode of delivering healthcare services via information and communication technologies to facilitate diagnosis, consultation, treatment, and care management. For Pasadena Clinical Group, telehealth encompasses synchronous (real-time) audio-video sessions, as well as audio-only telephone sessions when clinically appropriate and consented to. Asynchronous modalities (e.g., email, secure messaging) may be used for administrative communications but are not a substitute for live clinical sessions.
2. Informed Consent for Telehealth
In accordance with California Business and Professions Code § 2290.5(b), informed consent must be obtained from you before your first telehealth encounter. By agreeing to this Telehealth Services Agreement, you acknowledge that you have been informed about the use of telehealth technologies in your care, and you provide your consent to receive mental health services via telehealth. You have the right to refuse telehealth services at any time and to request in-person care instead, consistent with therapist availability and clinical appropriateness.
3. Technical Requirements
To participate in telehealth sessions, you must have access to:
- A device capable of running our HIPAA-compliant telehealth platform (e.g., computer, tablet, or smartphone with a camera and microphone)
- A stable internet connection with sufficient bandwidth for real-time video transmission
- A private, quiet location where confidential conversation can occur without interruption or unauthorized listeners
- Up-to-date software (operating system and browser) to ensure compatibility and security
Pasadena Clinical Group provides telehealth services through a HIPAA-compliant, encrypted platform selected to meet federal and state privacy and security standards. You should not use public Wi-Fi networks for telehealth sessions. We recommend a private, password-protected internet connection. The Practice is not responsible for technical failures on your end that may disrupt or compromise a session.
4. Limitations and Emergency Situations
Telehealth is not appropriate for psychiatric emergencies. If you are experiencing a mental health crisis, you must not rely on telehealth services as a primary intervention. Instead:
- Call or text 988 for the Suicide & Crisis Lifeline (available 24/7)
- Call 911 for life-threatening emergencies
- Go to your nearest emergency room
Telehealth sessions are not monitored continuously outside of scheduled appointment times. If you experience a technical disruption during a session, your therapist will attempt to re-establish the connection. If reconnection is not possible, your therapist will contact you by phone to determine whether the session can continue via audio-only format.
5. Interjurisdictional Licensure Requirement
Under California law and the licensing regulations of the California Board of Psychology and the California Board of Behavioral Sciences, Pasadena Clinical Group’s therapists are licensed solely in the State of California. You must be physically located within the State of California at the time of each telehealth session. If you are traveling or residing outside California, we cannot provide telehealth services to you. By participating in a telehealth session, you represent and warrant that you are physically present in the State of California. If you relocate outside California, you must notify the Practice immediately so that appropriate discharge planning and referrals can be arranged.
6. Availability
Pasadena Clinical Group offers telehealth appointments seven (7) days per week, including evenings and weekends, consistent with our standard operating hours (Monday through Friday 8:00 a.m. – 8:00 p.m., Saturday and Sunday 8:00 a.m. – 4:00 p.m. Pacific Time). Telehealth availability is subject to therapist scheduling and may vary by provider.
7. Recording Prohibition
The recording of any telehealth session — whether audio, video, screen capture, or any other form — by either the therapist or the patient is strictly prohibited without the prior express written consent of both parties. This prohibition includes any use of third-party recording applications, external cameras, or transcription services. If recording consent is granted for a specific clinical purpose (e.g., clinical supervision, training, or a specific therapeutic technique), the written agreement will detail the scope of recording, the storage location, the retention period, and the identities of any individuals authorized to view the recording.
8. Privacy and Confidentiality in Telehealth
All telehealth sessions are conducted using a HIPAA-compliant, encrypted platform selected and administered by Pasadena Clinical Group. The same confidentiality protections, limits, and exceptions that apply to in-person sessions apply to telehealth sessions (see our Treatment Consent for details). You are responsible for ensuring that your physical environment during telehealth sessions is private and secure. The Practice cannot guarantee confidentiality against unauthorized listening or observation that occurs within your physical location, nor against breaches caused by malware, compromised devices, or insecure networks on your end. You are encouraged to use a headset or earbuds to minimize the risk of others overhearing your session.
9. Information Only; No Self-Diagnosis Through Telehealth Materials
Educational materials, intake forms, screeners, mood-tracking tools, handouts, downloadable PDFs, recorded videos, podcasts, blog content, and any other resources delivered to you through our telehealth platform or in connection with telehealth services are provided strictly for general informational and educational purposes. They are not a substitute for individualized clinical evaluation, do not constitute medical or mental-health advice, and must not be used to self-diagnose or self-treat any condition. Diagnosis and treatment decisions are made only by a licensed clinician in the context of an established treatment relationship and a complete clinical assessment.
10. Assumption of Technology Risks; No Warranty
You acknowledge that telehealth depends on third-party hardware, software, internet connectivity, and electrical infrastructure, all of which are subject to disruption, latency, dropped sessions, audio or video distortion, software bugs, security incidents, denial-of-service attacks, vendor outages, and Force Majeure events. You acknowledge that no telehealth platform — even one that is HIPAA-compliant and end-to-end encrypted — can guarantee absolute confidentiality, security, or uninterrupted service. You knowingly, voluntarily, and expressly assume all such risks and agree that the Released Parties shall not be liable for any loss, harm, exposure, or delay attributable to such risks, except to the limited extent that liability cannot lawfully be disclaimed. The telehealth platform and all related services are provided “AS IS” and “AS AVAILABLE,” without warranty of any kind, express or implied, to the maximum extent permitted by law.
11. Limitation of Liability and Released Parties (Telehealth)
To the fullest extent permitted by law, Pasadena Clinical Group and each of its parent companies, subsidiaries, affiliates, owners, members, managers, partners, officers, directors, shareholders, supervising clinicians, employees, independent contractors, 1099 clinicians, supervisees, interns, post-doctoral fellows, externs, trainees, students, volunteers, peer-support workers, administrative staff, vendors, agents, attorneys, accountants, insurers, indemnitors, telehealth platform providers, EHR vendors, payment processors, successors, and assigns (collectively, the “Released Parties”) shall not be liable for any indirect, incidental, special, consequential, exemplary, or punitive damages arising out of or relating to your use of telehealth services, the telehealth platform, or any technology issue. Each Released Party is an intended third-party beneficiary of this limitation of liability and is entitled to enforce it directly. Nothing in this Section limits liability for any conduct that, as a matter of California or federal law, cannot be limited (including under Civil Code § 1668), nor does it waive any patient’s right to file a complaint with any licensing board or governmental regulator.
12. Out-of-State Travel; Cross-Border Telehealth
Because our clinicians are licensed only in California, you must remain physically present in California during every telehealth session. You agree that you will not request, schedule, attend, or participate in a telehealth session while you are physically located outside the State of California, and you assume sole responsibility for any consequence (including any unauthorized practice-of-medicine or licensing-board exposure) arising from any misrepresentation about your physical location. You agree to indemnify and hold harmless the Released Parties from any Claim arising out of your participation in a telehealth session from a location outside California or any jurisdiction in which any Released Party is not licensed.
13. Mandatory Pre-Suit Notice, Mediation, and Binding Individual Arbitration
Any dispute arising out of or relating to this Telehealth Agreement, the telehealth platform, the technology used to deliver telehealth, or any communication or session occurring through telehealth shall be resolved as follows, to the maximum extent permitted by California and federal law: first, by written notice to the Practice and sixty (60) days of good-faith negotiation; second, by non-binding mediation administered by JAMS (or, by mutual agreement, by the AAA Healthcare Mediation Rules) in Los Angeles County, California; and third, if not resolved, by final and binding individual arbitration administered by JAMS pursuant to the JAMS Comprehensive (or Streamlined) Arbitration Rules & Procedures and the JAMS Consumer Minimum Standards (or, by mutual agreement, by the AAA Healthcare Payor Provider Rules), in Los Angeles County, California, before a single neutral arbitrator, governed by the Federal Arbitration Act, 9 U.S.C. § 1 et seq., and the California Arbitration Act, Code of Civil Procedure § 1280 et seq. The parties expressly waive any right to a jury trial; expressly waive any right to participate in any class, collective, mass, consolidated, representative, or private-attorney-general action (other than as expressly preserved by non-waivable statute); and agree to a one-year shortened limitations period for any Claim. NOTICE: California Code of Civil Procedure § 1295(a): “By signing this contract you are agreeing to have any issue of medical malpractice decided by neutral arbitration and you are giving up your right to a jury or court trial.” A patient may rescind this Section (and only this Section) by written notice within thirty (30) days of first agreeing to it; rescission does not affect any other Section. Detailed dispute-resolution terms (including fee allocations, equitable-relief carve-outs, and severance of unenforceable class waivers) are set forth in our Terms & Conditions, incorporated by reference.
14. Contact Information
For questions about this Telehealth Agreement or our remote care services: