Tele-Rehabilitation Informed Consent Form

Tele-rehabilitation (remote rehabilitation) is the delivery of rehabilitation services using secure digital platforms, video conferencing, audio communication, messaging, and other electronic means.

Services include:

• video-based occupational therapy, physiotherapy, or speech and language therapy sessions
• guided exercise programs delivered remotely
• progress tracking and assessment via digital tools
• follow-up care and educational content delivered digitally
• asynchronous messaging and communication with licensed clinicians

Benefits may include:

• accessibility and convenience (services from home or preferred location)
• reduced travel time and costs
• flexible scheduling aligned with your availability
• continuity of care through documented progress tracking
• access to specialists who may not be available locally
• secure communication channels for follow-up and support

While tele-rehabilitation is evidence-based and effective for many conditions, certain risks and limitations exist.

A. Technology Risks

• internet connectivity issues may cause session interruption or poor video/audio quality
• technical failures may affect session delivery or data security (though we use encrypted channels)
• delays in communication or session availability may occur

B. Clinical Limitations

• clinical assessment via video is not equivalent to in-person physical examination
• certain conditions may require in-person evaluation or hands-on treatment not possible via tele-rehabilitation
• the clinician may determine that in-person services are more appropriate for your condition
• emergency medical situations cannot be managed through tele-rehabilitation

C. Privacy and Security Risks

• data transmitted over the internet may be subject to unauthorised access if security protocols are not followed
• we use industry-standard encryption, but absolute security cannot be guaranteed
• you are responsible for maintaining privacy in your personal space during video sessions

D. Environmental Risks

• tele-rehabilitation requires a safe environment free from hazards (e.g., trip hazards, poor lighting, unstable seating)
• you are responsible for preparing your space to safely perform prescribed exercises
• we assume no liability for injuries sustained in your home environment during or after sessions

You are eligible for tele-rehabilitation if:

• you have a stable internet connection and appropriate device (smartphone, tablet, or computer with camera/microphone)
• you can participate in a confidential video session from a private or semi-private space
• you have been assessed and cleared by a clinician for remote delivery
• your condition is suitable for remote management as determined by your assigned clinician
• you do not have contraindications (emergencies, severe mental health crises, or conditions requiring immediate physical intervention)

You explicitly acknowledge and agree that:

• tele-rehabilitation is NOT an emergency service
• if you experience a medical emergency, you will NOT rely on tele-rehabilitation and will immediately contact local emergency services (ambulance, hospital, or emergency department)
• red-flag symptoms (chest pain, severe shortness of breath, loss of consciousness, stroke symptoms, seizures, suicidal thoughts, severe allergic reactions, uncontrolled bleeding, or suspected fractures) require immediate emergency care, not tele-rehabilitation
• we are not responsible for delays in emergency response if you attempt to use tele-rehabilitation during an emergency

You may withdraw this consent at any time by notifying us in writing or through the platform. Withdrawal does not affect the legality of any prior use of tele-rehabilitation services.

Your assigned clinician retains the authority to:

• discontinue tele-rehabilitation if they determine it is not clinically appropriate
• require in-person assessment or treatment if the remote format becomes unsuitable
• refer you to appropriate in-person services or emergency care as needed

By consenting to tele-rehabilitation, you also consent to:

• secure audio/video recording of sessions for quality assurance, clinical documentation, and treatment planning purposes
• storage of session recordings and clinical notes in secure digital archives
• use of your anonymised health data for quality improvement and research (with additional written consent for research use)

Please see our Privacy Policy for full details on data handling and retention.

Connect Therapies, Thera Nexa Private Limited, and our clinicians are not responsible for:

• injuries sustained in your home environment during or after sessions
• losses, damages, or complications arising from improper execution of prescribed exercises
• loss of data or service interruption due to internet or technology failures (though we maintain security measures to minimise this risk)
• outcomes or lack of improvement despite consistent participation and adherence
• consequences of failure to disclose relevant medical history, medications, or contraindications

By using tele-rehabilitation services on the Connect Therapies platform, you agree to all terms stated in this Informed Consent Form. This form is effective as of the date you create your account on Connect Therapies or the date you first participate in a tele-rehabilitation session, whichever is earlier.

If you have any questions about this Informed Consent Form or tele-rehabilitation services:

Thera Nexa Private Limited

Support Contact: ct.support@theranexa.co.in

Grievance Officer: ct.support@theranexa.co.in