Consent for Telehealth Treatment

This Consent for Telehealth Treatment applies whenever you receive lactation support services from North Shore Lactation, LLC (“NSL,” “we,” “us,” or “our”) by live video, phone, or other remote technology (“Telehealth”), rather than in person. It supplements, and should be read together with, our general Consent for Care. By proceeding with a telehealth appointment, you acknowledge that you have read, understand, and agree to the following.

Last Updated: August 21, 2026

What Telehealth Is

Telehealth means the delivery of lactation support services using secure, real-time video and audio technology, and may also include phone calls, secure messaging, or photo and video sharing between visits, in place of an in-person visit. Your IBCLC will use their professional judgment to determine whether your concerns can be appropriately addressed by Telehealth or whether an in-person or in-home visit is recommended instead.

Potential Benefits of Telehealth

Telehealth can offer greater convenience, faster access to care, and the ability to receive support from home during a sensitive and often physically demanding period. It can be particularly useful for follow-up visits, general education, feeding-plan check-ins, and situations where an in-person visit is not immediately necessary or available.

Risks and Limitations of Telehealth

I understand that Telehealth has limitations that differ from an in-person visit, including that:

• My consultant cannot physically examine me or my baby, which may limit their ability to fully assess latch, positioning, oral anatomy, or breast/chest conditions.
• Video and audio quality, lighting, camera angle, and internet connectivity can affect what my consultant is able to see and hear, and may affect the accuracy of any assessment or recommendation.
• Technical problems (dropped connections, audio or video failure, platform outages) may interrupt or delay my visit.
• In some cases, my consultant may determine that Telehealth is not appropriate for my concern and may recommend an in-person or in-home visit, or referral to another healthcare provider, instead.
• As with any electronic communication, there is a small risk that information transmitted during a Telehealth visit could be intercepted or accessed by an unauthorized third party, despite the security safeguards described below.

Location of Care

I understand that I must be physically located within the United States, and I confirm that I am located within Illinois or another state where NSL is able to provide services, at the time of my Telehealth visit. I agree to inform my consultant if I am located outside of Illinois at the time of my appointment, as this may affect the services that can be provided and, for certain licensed providers involved in my care, may be restricted by state law.

Technology and Your Environment

To help your Telehealth visit go smoothly, please plan to have:

• A private, well-lit space free from distractions, where you feel comfortable discussing sensitive health information and, where relevant, positioning or latching your baby on camera.
• A stable internet connection and a device with a working camera and microphone.
• Awareness that other people in your household may be able to see or hear part of your session unless you are in a fully private room; NSL is not responsible for the privacy of your physical location.

Privacy and Security

NSL uses a secure, encrypted video platform intended to comply with HIPAA requirements for Telehealth. However, no method of electronic transmission or storage is completely secure, and NSL cannot guarantee that a Telehealth session will never be subject to an unauthorized interception or breach. NSL will not record Telehealth sessions without your separate, specific permission, and you likewise agree not to record any portion of your visit without your consultant's consent. Records from Telehealth visits are maintained and protected in the same manner as in-person visit records, as described in NSL's Privacy Policy and HIPAA Notice of Privacy Practices.

Emergencies

I understand that Telehealth is not appropriate for medical emergencies and that my consultant may not be able to respond immediately during a Telehealth session. If I or my baby are experiencing a medical emergency, I will call 911 or go to the nearest emergency room rather than wait for or attempt to use a Telehealth visit.

Your Right to Choose In-Person Care

I understand that Telehealth is voluntary. I may decline a Telehealth visit and request an in-person or in-home appointment instead, subject to availability, and I may withdraw from a Telehealth visit at any time without affecting my ability to receive in-person care in the future.

Financial Responsibility

I understand that Telehealth visits are billed consistent with NSL's Payment Policy, and that insurance coverage for Telehealth lactation visits varies by plan and, in some cases, by the location from which I receive care. If I do not have insurance, or choose not to use it, I understand that self-pay rates are available upon request and that, as an uninsured or self-pay patient, I have the right under the federal No Surprises Act to request a Good Faith Estimate of expected charges before my visit.

Duration of Consent

I understand that this Consent for Telehealth Treatment remains in effect for all current and future Telehealth visits with NSL unless I revoke it in writing, and that I may revoke this consent at any time by notifying NSL, without affecting care already provided.

Updates to This Consent

We may update this Consent for Telehealth Treatment from time to time to reflect changes in our practices, technology, or applicable law. When we do, we will post the revised version on this page and update the “Last Updated” date above. Please review this Consent periodically to stay informed.

By proceeding with a Telehealth visit, I confirm that I have read, understand, and voluntarily agree to this Consent for Telehealth Treatment, and that I have had the opportunity to ask questions before my visit.

Questions about this Consent for Telehealth Treatment? Contact us at: