Informed Consent for Services

This form describes the counselling and session policies for care provided through Spring Care, Inc. and its subsidiaries and affiliates, including Spring Care Limited (Ireland), operating under the brand name Spring Health, and includes:

Your consent to receive counselling from a Spring Health affiliated provider; and

Your agreement to receive services using telehealth technology.

By checking “I agree to Spring’s Consent for Services,” you agree you that you have read and understood the following:

1. I understand that I have the right to withhold or withdraw my consent to the use of telehealth services in the course of my care at any time.
2. I understand that a variety of alternative methods of care may be available to me.
3. I understand that if I am having a medical emergency that I should immediately contact my personal physician, local emergency notification system, or go to the nearest emergency room.
4. I understand that it is my duty to inform my provider of interactions regarding my care that I may have with my healthcare providers to the extent they are relevant. 
5. I have read and understand the information provided below.
6. I have read the conditions of Spring Health member “Member” responsibility / missed appointment policy and agree to the policies outlined herein.

SPRING HEALTH SERVICES AND RELATED POLICIES

Services may be performed using telehealth as a treatment modality. These services will be provided by therapists who are independent of Spring Health, including professionals with qualifications and / or registrations with applicable professional bodies required to provide the relevant services in your country, state or locality, and may include , psychologists,  therapists, counsellors,  or other specialists.

Spring Health  does not itself provide any medical or healthcare services or treatment of any kind. This document is for information purposes only and should not be interpreted as medical advice. 

Limitations to Evaluation Types

Spring Health providers are not able to provide the following types of evaluations: medication management, a return to work fitness for duty evaluations, parental custody evaluations, court-mandated treatment, emotional support animal evaluations, or other similar administrative evaluations. Members may request a copy of their Member record or ask for a statement letter for attendance at sessions.  Members can share these records directly with any agency of their choice. Providers will not send your records directly to any third party that is not involved in your care unless you have given written authorisation.

Telehealth as a Treatment Modality

Telehealth involves the use of audio, video and other electronic communications to enable providers to access individual Member information for the purpose of care. As part of this process, your provider may need to verify your identity as well as ask your location during a session to provide effective care. Details of your personal health information may be discussed with you through the use of interactive video, audio, or other telecommunications technology. Some Members do not find distance counselling to be as intimate or helpful as traditional in-person counselling. Oftentimes, this is because it is a new way of communicating. However, many Members find that after they have participated in several sessions that they can benefit from using telehealth. If you decide telehealth is not for you, you should promptly notify your therapist or Spring Health Care Navigator.

Expected Benefits of Telehealth: 

• improved access to care by enabling a Member to obtain consultations from a wider range of providers at distant/other sites that are not available for in-person care;
• more efficient evaluation and management with a wider range of appointment availability compared to only in-person care; and
• more convenient care scheduling and logistics.

Possible Risks of Telehealth: 

As with any evaluation and treatment, there are potential risks associated with the use of telehealth. These risks include, but may not be limited to:

• in rare cases, information transmitted may not be sufficient (e.g. poor connectivity) to allow for appropriate decision making by providers;
• delays in evaluation and treatment could occur due to deficiencies or failures of the equipment;
• in very rare instances, security protocols could fail, causing a breach of privacy of personal information;
• in some cases, it may be difficult for providers to track your location and guide your care in emergency situations; and
• In some cases, you may have multiple individuals involved with your care to determine the ideal plan of treatment.

Electronic Information/Systems:

Electronic information collected by providers during your sessions may be used for counselling, follow-up and/or education, and may include any of the following:

• Member records and electronic/paper communications;
• live two-way audio and video; and/or
• output data from sound and video files.

Electronic systems used in your care will incorporate network and software security protocols to protect the confidentiality of your identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Spring Health may send electronic appointment reminders to your phone.

Basic Information on Data Protection and Personal Health Information Data Management:

Spring Health uses, handles and protects your personal information and data in accordance with the Spring Health Privacy Notice. Upon your consent, you authorise the processing of your personal data for the proper provision of the telehealth service. In this regard, Spring Health provides for the communication of your data to third parties and for international transfers of personal data, subject to appropriate safeguards in accordance with applicable law. You have the right to access, rectify and erase data, as well as other rights, as explained in the aforementioned Privacy Notice. Please contact your care navigator if you have any further questions.

Member Responsibility/Missed Appointment Policy:

• Spring Health is not an enrolled provider in any government or universal health care schemes.
• You understand all appointments have to be confirmed by you in advance to retain your time slot.
• If you cancel an appointment within 24 hours of a scheduled telehealth appointment, then you may be responsible for a cancellation processing fee (or will have an employer-sponsored appointment deducted).
• If you are over 10 minutes late to a telehealth therapy appointment, it is up to the provider’s discretion to cancel or shorten an appointment. If cancelled, then you may be responsible for a cancellation fee as above.