I voluntarily consent to my child receiving PT, OT, and/or Speech Therapy services through telehealth when clinically appropriate.*

I understand telehealth uses secure audio/video technology and may have technical limitations.*

I understand that a parent, legal guardian, or authorized adult must remain present during my child's telehealth session and may be required to actively assist with treatment activities as directed by the therapist.*

I will provide a safe, quiet environment with adequate space, lighting, and internet access.*

I understand my privacy will be protected to the extent permitted by law and that I will not record sessions without prior written permission from PTS.*

I understand attendance, cancellation, billing, and insurance policies remain in effect for telehealth services. I understand that a valid form of payment must remain on file with PTS for any applicable copayments, coinsurance, deductibles, or other appointment-related fees.*

I understand I may withdraw my consent for telehealth at any time by notifying PTS.*