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INFORMED CONSENT

INFORMED CONSENT FOR ONLINE CONSULTATION

Clinic Name: MIND IT – Mental Health Clinic
Mode of Consultation: Online (Video / Audio)
Applicable Jurisdiction: India

Nature of Tele-Psychiatric/Tele-Psychotherapy Consultation

Tele-psychiatry/Tele-Psychotherapy involves providing consultation/session using secure electronic communication methods when the patient and psychiatrist/Therapist are in different locations.

By consenting, I understand that:

  •  The consultation will be conducted online only
  • Session duration may vary (typically 30–60 minutes)
  • Assessment is based on history, observation, and discussion
  • A limited virtual examination may be conducted
  • In-person examination may be advised if clinically necessary.

Appointment, Records & Prescriptions

  • Consultations are strictly by prior appointment only
  • Clinical notes are maintained securely as per medical standards
  • Prescriptions (if indicated) will be sent digitally after consultation
  • Certain medications may require in-person evaluation before prescription
  • Technical issues may lead to rescheduling if required.

Confidentiality & Privacy

  • All information shared during the consultation is confidential
  • Medical privacy laws apply equally to online consultations
  • Recording (audio/video) is strictly prohibited by either party without explicit written consent
  • The patient is responsible for ensuring privacy at their location
  • In rare cases, data breaches by service providers may occur beyond clinical control.

Limitations of Online Consultation

I understand that the following are not provided via online consultation:

  • Emergency care (acute agitation, suicide risk, medical emergencies)
  • Proxy consultations (patient must be present)
  • Medical certificates, legal documents, or disability certificates
  • Crisis intervention services

In emergencies, I agree to seek immediate local medical help.

Risks & Responsibilities

  • Medications may have side effects; I agree to report any adverse effects immediately
  • I am responsible for providing accurate and truthful information
  • I understand that treatment outcomes cannot be guaranteed
  • I may be advised referral or in-person evaluation when clinically indicated.

Right to Refuse or Withdraw Consent

  • Patient may refuse or withdraw consent at any time
  • Withdrawal will not affect future care
  • Consent withdrawal can be communicated verbally or in writing.

Legal & Regulatory Framework

This consultation is governed by:

  • Telemedicine Practice Guidelines, India (2020)
  • Mental Healthcare Act, India (2017).

Declaration & Consent

I confirm that:

  • I have read and understood the above information
  • My questions (if any) have been addressed
  • I consent voluntarily to receive online psychiatric consultation from MIND IT – Mental Health Clinic
  • I agree not to record the consultation without explicit written permission.