Consent to Telehealth

By using our website and services, I give my informed consent to the rendering of remote care via telephone, video or other electronic means, including asynchronous technology, by the health care provider that treats me through the Dynamic Moves Physical Therapy platform. Care may include, but is not limited to, obtaining a medical history, providing remote professional physical therapy services and providing follow-up treatment, as needed.

I understand that using the Dynamic Moves Physical Therapy platform involves the delivery of health care services by a health care provider to a patient that is located at a different site by using electronic information and communication technologies. Electronic communication technologies, including audio, video, and/or data communications may be used between the patient and health care provider to transmit data including, but not limited to, personal health information, photographs, videos, prescriptions/orders and medical records. I understand that the remote health care services may be provided by new technologies not included in this consent.

I understand that the laws that protect privacy and confidentiality of my medical information also apply to these services.

I understand that the health care provider has the right to determine that my medical condition is not appropriate for remote treatment and as a result, I may need to seek alternative treatment methods or settings, such as but not limited to in-person or in-home physical therapy.

I understand that the outcomes from the practices of telehealth/remote physical therapy are similar in success rates as traditional practices, however I acknowledge and understand results may vary depending on a multitude of factors.

I understand that there are risks and benefits to receiving remote health care services.

Benefits of Remote Health Care Services Include the following:

Remote health care can be more accessible and allows you to receive care without the wait and at a time and place that is convenient for you.

Remote health care can improve communication between you and your health care provider.

Remote health care is subject to the same privacy protections as in-person health care visits.


A remote physical therapy examination may differ in nature and feel different from an in-person physical therapy examination.

The transmission of protected health information and any data via the internet could result in a data breach, subjecting your health information to exposure.

Technology problems can disrupt internet connections, interrupt an appointment or otherwise cause a delay to your receipt of treatment.

I hereby acknowledge that I am aware of all potential risks associated with receiving remote health care services. I acknowledge that no guarantees have been made to me regarding the result of a diagnosis or treatment provided to me by health care providers affiliated with the Dynamic Moves Physical Therapy platform.

I have disclosed all my known health conditions, allergies and medications I am taking, including herbal medications/supplements. I understand that physical therapy may be dangerous if I do not disclose any and all known serious or non-serious medical conditions. Based on my individual medical history, my Dynamic Moves Physical Therapy physical therapist will help determine potential risk factors for physical therapy.

I authorize the Dynamic Moves Physical Therapy affiliated health care provider to share information pertaining to my remote treatment with other Dynamic Moves Physical Therapy employees and professionals for treatment, payment and health care operations purposes. I authorize the affiliated health care providers to release information pertaining to my remote medical treatment to Dynamic Moves Physical Therapy and its affiliates.