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Refresh Income Counseling, LLC 800 Main Street, Ste. 210, Antioch, IL 60002 PH: (847× 9035604 * FAX: (224× 7885112 www.inhomecounselingservices.comInformed Consent for TeleHealth This Informed Consent
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Anyone who wishes to receive in-home counseling services for seniors through telehealth at www.inhomecounselingforseniors.com
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It is a form that allows individuals to provide consent for receiving telehealth services through the website www.inhomecounselingforseniors.com.
Any individual who wishes to receive telehealth services through the website www.inhomecounselingforseniors.com is required to file the consent form.
To fill out the consent form, individuals need to provide their personal information, agree to the terms and conditions of telehealth services, and submit the form online.
The purpose of the consent form is to ensure that individuals understand and agree to receive telehealth services through the website www.inhomecounselingforseniors.com.
The consent form must include personal information of the individual, agreement to telehealth services terms, and any relevant medical history or conditions.
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