In the below consent, the patient is referred to as “I, me or my”,                                                                                                                1. I understand that the Physiotherapist wishes me to engage in TeleRehab sessions.                                                                          2. The Physiotherapist has explained to me how the video conferencing technology will be used for such sessions and will not be the same as a direct patient/health care provider visit. This is due to the fact that I will not be in the same room as the physiotherapist.                                                                                                                                                                                               3. I understand there are potential risks to this technology, including interruptions, unauthorized access and technical difficulties. I understand that the physiotherapist or I can discontinue the TeleRehab session if it is felt that the videoconferencing connections are not adequate for the situation.                                                                                                                   4. I have been explained that TeleRehab program will include physical exercises as a part of my recovery/ condition. The levels of exercises which will be undertaken will be based on my physical status, medical history, cardiovascular-pulmonary responses to the exercise test and the advice of the physician. The exercise session will be adjusted depending on my progress and responses to the activities.                                                                                                                                                                           5. I have had the alternatives to TeleRehab session explained to me and I am choosing to participate in TeleRehab sessions. I understand that some parts of the exam involving physical tests may be conducted by individuals at my location (family or friend) at the direction of the consulting health care provider.                                                                                                                 6. There exists the possibility of certain abnormal changes occurring during the exercise sessions. These include abnormal blood pressure, fainting, irregular heartbeat, and in rare instances Heart attack, stroke or death. Efforts will be made to minimize these risks by a preliminary assessment and by appropriate supervision during the exercise. If during the session the patient experiences any medical complications or emergency, the family or guardian shall be responsible to provide medical attention. The TeleRehab services then will be terminated, and will be referred to an appropriate level of care.                                                 7. I understand that payment transactions will be prepaid.                                                                                                                       8. Cancellation policy: Minimum 24 hours’ notice is required from the appointment time if the patient will not be able to participate in your TeleRehab session. Spot cancellations or any cancellation less than 24 hours would be chargeable.