Telehealth Informed Consent

Effective Date: March 25, 2026

This Telehealth Informed Consent (“Consent”) describes the terms, benefits, risks, and limitations of receiving healthcare services through telehealth technology offered by The McPeak Method and McPeak Behavioral Health (“we,” “us,” or “our”), operated by Justin McPeak, NP-C.

By requesting, scheduling, or participating in a telehealth visit, you acknowledge that you have read, understand, and agree to the terms outlined below.

1. What Is Telehealth?

Telehealth is the delivery of healthcare services using electronic communications, including video conferencing, phone calls, secure messaging, and other digital tools. Telehealth allows you to receive evaluation, diagnosis, consultation, treatment, and follow-up care from a licensed provider without being in the same physical location.

2. Services Provided via Telehealth

We may provide the following services through telehealth, as clinically appropriate:

• Psychiatric evaluation and diagnosis
• Psychotherapy and counseling
• Medication management and prescribing
• Follow-up visits and treatment plan adjustments
• Life coaching and wellness consultations
• Care coordination and referral discussions

3. Benefits of Telehealth

Potential benefits of telehealth include:

• Access to care from your home or any private location with an internet connection
• Reduced travel time and associated costs
• More flexible scheduling, including evening and weekend availability
• Continuity of care when in-person visits are not feasible
• Timely access to your provider for urgent non-emergency concerns

4. Risks and Limitations

Telehealth has limitations compared to in-person visits. By consenting to telehealth services, you acknowledge the following risks:

• Technology may fail, causing delays or interruptions during a session. If a session is disrupted, your provider will attempt to reconnect or follow up by phone.
• The provider may not be able to perform a hands-on physical examination. Certain conditions may require an in-person visit or referral to another provider.
• Despite reasonable security measures, electronic communications carry some risk of interception or unauthorized access.
• Audio or video quality may vary depending on your internet connection and equipment.
• In rare cases, the provider may determine that telehealth is not appropriate for your condition and may recommend an in-person evaluation.

5. Your Responsibilities

To participate in telehealth services, you agree to:

• Be located in the state of Georgia or another state where your provider is licensed at the time of your visit
• Provide accurate and complete information about your medical history, current symptoms, medications, and any other relevant health information
• Be in a private, quiet location where you can speak openly with your provider
• Use a device with a reliable internet connection, working camera, and microphone for video visits
• Inform your provider if you are experiencing a medical or psychiatric emergency, and understand that telehealth is not a substitute for emergency services

6. Emergency Situations

Telehealth services are not intended for medical or psychiatric emergencies. If you are experiencing a life-threatening emergency, call 911 immediately. If you are in crisis and need immediate mental health support, call or text 988 (Suicide and Crisis Lifeline).

By participating in telehealth, you agree to provide your physical location at the start of each session so your provider can direct emergency services to you if needed.

7. Privacy and Confidentiality

We take reasonable steps to protect the confidentiality of your telehealth sessions and health information. Telehealth sessions are conducted using secure, encrypted platforms. Your provider will conduct sessions from a private location.

Your health information is handled in accordance with applicable federal and state privacy laws, including HIPAA where applicable. Please review our Privacy Policy and Notice of Privacy Practices for additional details.

Telehealth sessions are not recorded unless you are informed in advance and provide separate written consent.

8. Prescribing via Telehealth

Your provider may prescribe medications based on a telehealth evaluation when clinically appropriate. Prescriptions will be sent electronically to the pharmacy of your choice. Certain controlled substances may be subject to additional federal and state requirements, and your provider will discuss any limitations with you.

9. Fees and Insurance

Telehealth visits are billed at the same rate as in-person visits unless otherwise stated. Coverage for telehealth services varies by insurance plan. You are responsible for verifying your insurance coverage and for any co-pays, deductibles, or out-of-pocket costs that apply.

If you are self-pay, fees will be disclosed before your visit. You may request a Good Faith Estimate of expected charges under the No Surprises Act.

10. Right to Withdraw Consent

Your consent to receive telehealth services is voluntary. You may withdraw your consent at any time by notifying us in writing or verbally during a session. Withdrawing consent will not affect your right to receive future in-person care, and your provider will discuss alternative care options with you.

11. Applicable Law

Telehealth services are provided in accordance with the laws and regulations of the State of Georgia and any other applicable state where the provider is licensed. This Consent is governed by the laws of the State of Georgia.

12. Changes to This Consent

We may update this Telehealth Informed Consent from time to time. When we do, we will update the effective date at the top of this page. Material changes will be communicated to active patients.

13. Contact Information

If you have questions about this Telehealth Informed Consent or our telehealth services, please contact:

The McPeak Method / McPeak Behavioral Health
Justin McPeak, NP-C
3343 Peachtree Road Northeast
Atlanta, GA 30305
Phone: +1 (678) 902-7995
Email: info@themcpeakmethod.com