Phone Consultation Consent

I request to participate in phone consultation(s) with APS Medical personnel. I understand that phone consultations are provided as a convenience to me. I further understand that the center personnel will make reasonable efforts to provide phone consultation(s) during Wisconsin’s pandemic response. I also understand that they may discontinue providing phone consultations to me if they are unable to meet my needs this way.

I understand that APS Medical only offers phone consultations to clients residing in the state of Wisconsin and that I am responsible to notify center personnel if I move out of Wisconsin. 

I understand that my consultation will be with nonmedical personnel of the center, including a client/patient advocate, and/or with a licensed professional. I also understand that consultations with unlicensed personnel are not a substitute for therapy and/or healthcare or for the advice of other licensed professionals. 

I understand that the phone service used by the APS Medical is not HIPAA compliant. I further understand that certain risks, including interruptions and technical difficulties, are inherent in online/phone communication and will not hold APS Medical liable for any breach of confidentiality resulting from the platform used for the consultation(s). 

APS Medical and its personnel/agents do not consent to any recording.