Telehealth Consent & Disclosure Notice
Mind Bloom La Jolla / Ana Lopez Hopkins, MSN, PMHNP-BC
For your convenience, appointments may be offered via telehealth (secure video or phone) in addition to in-person visits at our La Jolla office. Before your first telehealth appointment, please review the following:
What Telehealth Involves
Telehealth uses secure video conferencing or telephone technology to allow your provider to evaluate, diagnose, and treat you remotely, in the same way that would occur during an in-person visit. This may include psychiatric evaluation, medication management, and follow-up care.
Your Right to In-Person Care
You have the right to request an in-person visit instead of, or in addition to, telehealth services at any time. Choosing telehealth is voluntary, and you may withdraw your consent to telehealth and switch to in-person care at any point without affecting your access to future care.
Benefits and Limitations
Telehealth can increase access to care, reduce travel time, and offer flexibility in scheduling. However, it also has limitations:
- The provider is not physically present, so certain physical exams cannot be performed.
- Technical issues (connectivity loss, audio/video quality) may occasionally disrupt or delay a session.
- In a medical or psychiatric emergency, telehealth is not appropriate.
Emergency notice: If you are experiencing a medical or psychiatric emergency, call 911 or go to the nearest emergency room. You may also contact the 988 Suicide & Crisis Lifeline by calling or texting 988.
Privacy and Security
We use a HIPAA-compliant video platform designed to protect the confidentiality of your session. As with any technology, we cannot guarantee that electronic communication is 100% secure from interception. We recommend joining sessions from a private, secure location and network.
Confidentiality
The same confidentiality protections that apply to in-person mental health treatment apply to telehealth visits, including the standard exceptions required by California law (e.g., risk of harm to self or others, suspected abuse of a child or dependent adult, or court order).
Consent
By scheduling and participating in a telehealth appointment, you acknowledge that you have reviewed this notice, understand the benefits and limitations of telehealth, and consent to receiving care through telehealth. You may ask questions about telehealth at any time, and written consent will also be reviewed as part of your intake paperwork.
Questions
If you have questions about telehealth services, please contact:Mind Bloom La Jolla
1120 Silverado St. Suite 203, La Jolla, CA 92037
Phone: (858) 412-5141
Email: anahopkins@mindbloomlajolla.com