Consent to Telehealth Treatment

This is the default version emotilink providers may distribute if they do not upload their own. When you match with a provider, the version you receive will be filled in with that provider’s specific practice information (name, license, and other details shown in brackets below).

Your treatment with your Provider through the emotilink Platform.

Effective Date: July 18, 2026
Provider: [Your therapist’s name]
Provider License Number / State: [Your therapist’s license number and state of licensure]
Version: Default v1 (emotilink boilerplate; Provider may upload customized version via Provider Settings)

This document is your written consent to receive telehealth services from the licensed mental health professional named above (“your Provider,” “we,” “us,” or “our“) through the emotilink platform (the “Platform“). Please read it carefully before agreeing.

This is the default Consent to Telehealth Treatment provided to you on behalf of your Provider through the Platform. Your Provider may have adopted a customized Consent instead of this default. If so, your Provider’s customized Consent supersedes this one, and you can request a copy directly from your Provider.

This Consent is the agreement between you and your Provider regarding your treatment. It is separate from your agreement with emotilink, which is governed by the emotilink Terms of Use, Privacy Policy, and HIPAA Notice of Privacy Practices.

1. YOUR VOLUNTARY PARTICIPATION

Your participation in telehealth treatment with your Provider is voluntary. You may withdraw your consent and discontinue treatment at any time, for any reason, without penalty other than financial obligations that have already arisen under the emotilink Session Minimum and Cancellation Policy.

You have the right to ask questions about your treatment at any time, and your Provider will answer them to the best of their ability. If you choose not to receive treatment over telehealth, your Provider may be able to refer you to in-person services elsewhere; the Platform itself is a telehealth-only environment.

2. DESCRIPTION OF TELEHEALTH

Telehealth means the delivery of mental health services through secure, live, two-way audio and video technology, in which you and your Provider are in different physical locations and communicate in real time over the Platform.

Your sessions with your Provider take place inside the Platform’s encrypted real-time session interface. Audio and video between you and your Provider are encrypted end-to-end and are not recorded, stored, or accessible to emotilink. See the emotilink Privacy Policy for a fuller description of the Platform’s information practices.

3. RISKS AND BENEFITS OF TELEHEALTH

3.1 Benefits

Telehealth treatment over the Platform can provide significant benefits over in-person care, including:

  • Access to a Provider you might not otherwise be able to see
  • Reduced travel and scheduling burden
  • A familiar environment for sessions
  • Privacy from the experience of entering and leaving a clinical office

3.2 Risks

Telehealth treatment also carries risks that in-person care does not, including:

  • Technology failures. Internet connectivity, audio, or video may fail mid-session, requiring rescheduling.
  • Limited physical assessment. Your Provider cannot perform any physical examination over telehealth and may have less ability than an in-person clinician to assess your physical state (for example, if you are intoxicated, dehydrated, or experiencing a medication side effect).
  • Privacy considerations. A telehealth session is only as private as your environment makes it. If a third party is in the room or within hearing distance, your privacy may be compromised.
  • Emergency response delay. If you experience a medical or psychiatric emergency during a session, your Provider may not be able to assess or respond as quickly as an in-person clinician.
  • Identity considerations. Your Provider relies in part on the information you provide to verify your identity; misrepresentation of identity by you may put your treatment at risk and your Provider may decline to continue treatment.

You acknowledge and accept these risks as a condition of receiving telehealth treatment.

The Platform is designed for ongoing, scheduled or on-demand telehealth treatment with a licensed mental health professional. It is not appropriate for, and should not be used to address:

  • An active psychotic episode
  • Active suicidal ideation with a plan and intent to act
  • Active homicidal ideation
  • Severe substance use that requires medical detoxification
  • An eating disorder that has reached the threshold of medical instability
  • Court-ordered treatment that requires in-person attendance
  • Fitness-for-duty or independent medical examinations

If any of the above applies to you, you should not use the Platform for that condition and should seek in-person care or contact emergency services. If your Provider determines during the course of treatment that any of the above applies, your Provider will refer you to a higher level of care.

emotilink is also not a medical service. Your Provider, even if a licensed physician or other medical professional, does not prescribe medications, perform medical examinations, or deliver medical treatment over the Platform. If you require medication management or medical care, please see your physician or psychiatrist in person.

emotilink is not an emergency service. emotilink is not staffed 24 hours a day, 7 days a week.

If you are in immediate danger of harming yourself or others, or experiencing a psychiatric emergency:

  • Call or text 988 (Suicide and Crisis Lifeline)
  • Call 911 for immediate danger
  • Go to your nearest emergency room for a psychiatric emergency

Do not rely on the Platform or your Provider for an immediate response in a crisis. Even when your Provider has indicated that they are available for an on-demand session, there is no guarantee that any Provider will be available to meet you at any particular moment. In a crisis, please use 988, 911, or your nearest emergency room.

You can also review the emotilink Crisis Resources Notice for additional detail on the platform’s crisis posture, available at www.emotilink.com/crisis-resources.

6. PROVIDER AVAILABILITY AND COMMUNICATION

6.1 Scheduled and on-demand sessions

Your Provider sets their own schedule. Sessions with your Provider take place at the times your Provider has scheduled with you or, in the case of on-demand sessions, at times your Provider has indicated they are currently available.

Your Provider’s availability — including any “available now” or on-demand status — is at your Provider’s sole discretion. Your Provider is not obligated to be available outside scheduled sessions. Even when your Provider has set themselves available for an on-demand session, there is no guarantee that your Provider will accept any particular request.

6.2 Communications outside of sessions

emotilink is not equipped for between-session messaging between you and your Provider. There is no in-app direct-messaging capability between you and your Provider. Any messages you receive from emotilink are platform-generated, transactional or logistical in nature (for example, appointment confirmations and receipts), and contain no clinical content.

If you need to speak with your Provider, please schedule a session. If you need urgent help, please use the resources in Section 5.

7. CONFIDENTIALITY AND ITS LIMITS

7.1 General confidentiality

What you share with your Provider in session is confidential and is protected by federal and state law, including HIPAA. Your Provider will not disclose information about your treatment without your written authorization, except in specific situations described below.

7.2 Limits to confidentiality

Your Provider may be required by law to disclose information without your authorization in the following situations:

  • Mandatory reporting. Suspected abuse or neglect of a child, an elderly person, or a dependent adult; certain communicable diseases; or other categories that your Provider’s state of licensure designates as mandatory-report.
  • Duty to warn or protect. If you communicate a serious threat of physical violence against a reasonably identifiable third party, your Provider’s professional duties may require that your Provider take steps to warn the potential victim, notify law enforcement, or both.
  • Risk to self or others. If your Provider believes you are in imminent danger of harming yourself or others, your Provider may share information necessary to coordinate emergency care, including by activating the Platform’s emergency-reporting feature described in Section 8 and in the emotilink Privacy Policy.
  • Legal process. A valid court order, subpoena, or other legal process may require your Provider to disclose treatment records.
  • Reproductive health care. Consistent with the 2024 HIPAA Reproductive Health Rule, your Provider will not disclose information about your reproductive health care for purposes of investigation or imposition of liability, where the care was lawful in the circumstances. Your Provider will require a written attestation before disclosing such information in response to certain legal processes.

7.3 The Platform’s in-session 911 functionality

The Platform includes a 911 functionality built into the in-session interface for use by your Provider. If your Provider, in clinical judgment, believes an emergency requires immediate action, your Provider may use this functionality to share information with 911 authorities about your location and emergency contact information. Activation of this functionality is 100% your Provider’s discretion and functions analogously to a clinician calling 911 from a brick-and-mortar office. The information that may be shared in such a situation is described in the emotilink Privacy Policy at Section 8.

8. YOUR EMERGENCY INFORMATION

When you created your emotilink account, you provided your full name, your home address, and the name and telephone number of an emergency contact. You also granted the Platform permission to access your mobile device’s location services.

The Platform does not access your location at any other time other than when your Provider activates the in-session 911 functionality described in Section 7.3 (or under the limited additional circumstances described in the emotilink Privacy Policy). When that functionality is activated, the Platform shares your full name, home address, telephone number, emergency contact, and last recorded GPS location with your Provider and (as your Provider directs) with 911 authorities, so that emergency response can be directed to the correct location.

You agree to keep your home address and emergency contact information accurate and current. You may update them at any time through the Platform’s Settings menu.

9. YOUR PRIVACY RESPONSIBILITIES

You play a significant role in the privacy of your telehealth sessions. By engaging in telehealth treatment over the Platform, you agree to:

  • Use a private space. Conduct your sessions in a location where you are not overheard by others.
  • Secure your device. Take reasonable steps to keep your personal device (phone, tablet, or computer) free of unauthorized users and malicious software.
  • Use a secure network. Avoid public Wi-Fi for sessions where possible; if you must use a public network, do not consent to sharing your screen or device.
  • Do not record or share sessions. Recording, screenshotting, or sharing the audio or video of your sessions, or any other clinical communications, is prohibited. This protects both your privacy and the confidentiality of other Platform users.

Your Provider will likewise use a private space, secure their device, and refrain from recording sessions, except where recording is expressly authorized by you in writing.

10. IDENTITY VERIFICATION

To engage anonymously with Providers, you may use a display name that does not disclose your full identity. However, for your safety and your Provider’s clinical accuracy:

  • Your Provider will ask your name and your state of residence at the start of treatment.
  • Your Provider may ask you to display a government-issued photo identification during a session if your Provider believes additional verification is necessary for clinical, mandatory-reporting, or insurance purposes.
  • If you decline to provide your name or state of residence, your Provider may decline to begin or continue treatment.

You agree that the personal information you provide to your Provider (including your name, location, and any health history) is accurate, complete, and current to the best of your knowledge.

11. NO MEDICATION MANAGEMENT OR PRESCRIBING

emotilink is a counseling and therapeutic services platform. Your Provider, even if a licensed psychiatrist or other medical professional, will not prescribe medications, manage your existing medications, or provide other medical treatment over the Platform.

If you require medication, you should consult an in-person physician or psychiatrist. Your Provider may coordinate with your prescriber as part of your overall care, but only with your written authorization.

12. RIGHT TO WITHDRAW

12.1 Right to withdraw from telehealth

You may withdraw your consent to telehealth treatment at any time, for any reason, by notifying your Provider in writing or by terminating your engagement with your Provider through the Platform. Withdrawal of consent to telehealth does not affect treatment already received or financial obligations already accrued.

12.2 Right to return to in-person services

You may, at any time, discontinue treatment with your Provider over the Platform and seek in-person services with the same Provider (if available) or another clinician. emotilink does not restrict your right to seek in-person care.

12.3 Right to terminate treatment

You may terminate treatment with your Provider at any time. If your Provider determines that continuing treatment with you is not appropriate (for example, if your needs exceed what telehealth can support, or if any of the situations in Section 4 develops), your Provider may also terminate treatment, providing reasonable referrals where appropriate.

13. ACKNOWLEDGMENT

By accepting this Consent, you acknowledge that:

  • You have read this Consent and have had the opportunity to ask questions.
  • You understand the description, risks, benefits, and limits of telehealth treatment as described above.
  • You understand that emotilink is not for emergencies, that the Platform is not staffed 24 hours a day, and that in a crisis you should call or text 988, call 911, or go to your nearest emergency room.
  • You understand that there is no between-session messaging between you and your Provider.
  • You understand the limits of confidentiality, including mandatory reporting, duty to warn, and the Platform’s in-session 911 functionality.
  • You understand that your Provider does not prescribe medications or perform medical treatment over the Platform.
  • You understand your right to withdraw your consent and to terminate treatment at any time.
  • You consent to telehealth treatment with your Provider over the Platform on the terms set out above.

CONTACT

Your Provider:

[Your therapist’s name]
License: [Your therapist’s license number]
State of Licensure: [Your therapist’s state of licensure]

emotilink (Platform — Business Associate of your Provider):

emotilink, LLC
222 W Merchandise Mart Plaza, Suite 1230
Chicago, IL 60654
info@emotilink.com
312-554-5812

Emergency:

988 (Suicide and Crisis Lifeline) · 911 · Your nearest emergency room