Nureli Medical Group
Telehealth Informed Consent and Consent for Psychiatric Treatment
Effective Date:
Version: THIC-2026.11.01-1 · Last Updated:
1. Consent to Services and Treatment.
Nureli clinical services are provided through the applicable clinical entity based on the patient's physical location. In Texas, clinical services are provided by Nureli Medical Group, PLLC. In New Jersey, clinical services are provided by Nureli Medical Group, LLC. Nureli provides psychiatric evaluations, diagnostic assessments, medication management, follow-up care, and related mental healthcare services through telehealth. By consenting to treatment, patients authorize Nureli's licensed healthcare professionals to evaluate their symptoms, establish diagnoses, recommend treatment, prescribe medications when clinically appropriate, order diagnostic testing, and coordinate referrals. Telehealth may involve secure video, telephone, electronic messaging, and exchange of medical information. Benefits include improved accessibility, convenience, and continuity of care. Risks and limitations include technical failures, potential privacy breaches, incomplete clinical information, medication side effects, and the inability to perform certain physical examinations. Providers may require laboratory testing, in-person evaluation, or referral to another healthcare facility. No particular diagnosis, prescription, or treatment outcome is guaranteed. Patients must provide accurate health information, disclose their physical location during appointments, and participate in recommended follow-up care. Providers exercise independent clinical judgment and may decline or discontinue a particular treatment when medically inappropriate, subject to applicable professional obligations.
Laboratory monitoring may be recommended when clinically necessary for safe psychiatric medication management. Clients are responsible for completing recommended testing and applicable preparation instructions. Clients may decline testing and discuss alternatives with their clinician; refusal or incomplete monitoring may affect whether certain medications can safely be initiated, continued, or renewed. Decisions remain individualized and subject to applicable law, reasonable accommodations, and continuity-of-care obligations; declining testing does not by itself result in automatic discharge.
2. Privacy, Patient Rights, and Treatment Responsibilities.
Nureli protects patient information under applicable federal and state privacy laws, including HIPAA. Medical information may be shared with authorized healthcare professionals, pharmacies, laboratories, insurers, and service providers for legally permitted purposes. Confidentiality may be limited by mandatory reporting obligations, lawful court orders, public health requirements, or serious threats to safety. Patients may request information about their provider's credentials, ask questions about diagnoses and treatment alternatives, access their medical records, participate in treatment decisions, and refuse or withdraw consent to telehealth or proposed treatment, subject to applicable law and clinical considerations. Telehealth communications may involve electronic transmission of sensitive information and cannot be guaranteed entirely free of security risks. Nureli may use authorized AI-assisted documentation technologies subject to applicable privacy protections and any separately required consent. Audio or video recording will not occur without the permissions required by law. Secure patient messaging is not continuously monitored and must not be used for emergencies. Nureli does not provide emergency medical or psychiatric services. Patients experiencing an emergency should call 911 or visit the nearest emergency department; individuals experiencing a mental health crisis may call or text 988.
Patient Choice and Telehealth-Only Services
Participation in telehealth services is voluntary. Patients may decline or withdraw consent to telehealth at any time. Refusing telehealth does not, by itself, result in the loss of healthcare benefits or rights to future treatment to which the patient would otherwise be entitled.
Nureli Medical Group provides services exclusively through telehealth and does not offer in-person appointments. Because telehealth is the sole method of care delivery, patients who decline telehealth cannot receive clinical services from Nureli through an alternative in-person modality. When appropriate, patients may seek care from another healthcare provider offering in-person services.
All applicable confidentiality protections remain in effect for telehealth services. Patients retain their legal rights to access medical information generated during telehealth encounters.
Telehealth treatment requires the patient's informed agreement. Consent is documented through Nureli's existing electronic acknowledgment workflow before treatment begins.
3. State-Specific Requirements, Minors, and Legal Authorization.
Telehealth services are governed by applicable federal law and the laws of the jurisdiction where the patient is physically located during treatment. Additional requirements may apply to informed consent, prescribing, professional licensure, medical records, confidentiality, and patient disclosures. Nureli will provide additional notices or obtain additional consent when legally required. For patients under 18, treatment generally requires authorization from a parent, legal guardian, or other legally authorized representative unless applicable law permits or requires the minor to consent independently. Nureli may request documentation of custody, guardianship, emancipation, or other legal authority. Minor patients' confidentiality, parental access to records, and independent consent rights are determined by applicable law. Nureli may seek age-appropriate assent from minors when clinically appropriate. Consent to treatment remains voluntary and may be withdrawn as permitted by law; withdrawal does not automatically invalidate treatment previously provided or eliminate applicable medical-record retention obligations.
New Jersey Clinical Entity Disclosure
Psychiatric and mental health services provided to patients located in New Jersey are furnished by Nureli Medical Group, LLC. Clinical services are delivered by appropriately licensed healthcare professionals. Information regarding your treating clinician's identity, credentials, and applicable contact information will be provided in accordance with New Jersey law.
4. Fees, Self-Pay Pricing, and Insurance.
The cost of self-pay services is disclosed before scheduling or payment. Current self-pay pricing is $100 for an initial psychiatric evaluation, $50 for a follow-up appointment, and $199 for the one-time Nureli Flex Intake Package, and $199 for the one-time Nureli Flex Continuing Care Package. Year-End Care Event pricing is $79 for an initial evaluation and $179 for Flex Intake for eligible new self-pay patients through December 31, 2026, subject to published promotional conditions; any applicable package conditions are disclosed before purchase. Fees may change prospectively, and the pricing in effect is disclosed before purchase or scheduling. For patients using insurance, Nureli may bill participating insurance plans for covered services. A patient's financial responsibility depends on the individual's insurance plan and benefits, and copayments, deductibles, coinsurance, coverage limitations, and other out-of-pocket costs vary by plan. Insurance coverage and payment are not guaranteed merely because a patient schedules an appointment. Any applicable patient responsibility is determined under the insurance plan, the payer contract, and applicable law. Zoom appointments require joining at least 5 minutes before the scheduled start time, and arrival more than 5 minutes late is classified as a no-show; telephone appointments are available for eligible follow-up visits only, and an unanswered second call attempt is classified as a no-show. For self-pay initial psychiatric evaluations, a no-show results in $50 of the prepaid intake fee being retained as the no-show fee and the remaining balance refunded. Nureli's administrative and financial policies, including cancellation, late-rescheduling and no-show fees, payment timing, payment authorization, and refund and credit terms, are set out in the Financial Policy within Nureli's Terms of Service at https://nureli.health/terms.
Laboratory Testing Coverage for Self-Pay Clients
Nureli Medical Group may order clinically necessary laboratory testing in connection with psychiatric evaluation, medication initiation, medication management, and ongoing treatment. For eligible self-pay clients, Nureli Medical Group will cover the cost of clinically indicated laboratory testing ordered by an authorized Nureli clinician and processed through Nureli's approved Quest Diagnostics laboratory arrangement.
Covered testing is determined by the treating clinician based on medical necessity, medication-specific monitoring recommendations, and individualized clinical circumstances. Coverage is limited to testing ordered and authorized through Nureli's established laboratory workflow. Laboratory testing ordered by outside healthcare providers, performed through nonparticipating laboratories, or obtained without Nureli's authorization is not covered unless expressly approved in advance.
The laboratory coverage benefit does not guarantee that any particular test will be ordered or that a specific medication will be prescribed. Clients remain responsible for completing recommended laboratory testing and following applicable preparation instructions. Clients may decline testing; however, refusal or failure to complete clinically necessary monitoring may affect the clinician's ability to safely initiate, continue, or renew certain medications.
The benefit applies to eligible self-pay clients and does not automatically extend to services billed through commercial insurance, Medicare, Medicaid, or other third-party payers. Nureli will not charge eligible self-pay clients separately for covered laboratory testing performed under its approved arrangement.
The laboratory benefit applies to eligible self-pay clients receiving individual visits, Nureli Flex Intake (one initial evaluation and four follow-up visits), or Nureli Flex Continuing Care (four follow-up visits), subject to the same clinical necessity, authorization, laboratory arrangement, and eligibility conditions. Existing visit prices, package prices, included visits, expiration provisions, and refund terms remain unchanged.
Eligibility criteria, coverage exclusions, and any expected expense for testing outside the covered benefit will be disclosed before the client incurs laboratory expenses. Nureli will not impose an unexpected laboratory charge without appropriate advance disclosure and agreement, consistent with applicable law.
If you receive an unexpected Quest bill for testing you understood to be covered, contact Nureli through your existing secure patient portal or the practice telephone number so Nureli can review the order and billing arrangement and assist in resolving the issue with Quest. Please do not send laboratory results or other clinical information through public website forms or ordinary email. Nothing in this provision waives Nureli's responsibility for billing errors or rights and remedies under applicable law.
Nureli Flex Packages, Continuing Care, and Termination of Services
Nureli Medical Group offers optional self-pay care packages under the Nureli Flex program. The Nureli Flex Intake Package is a $199 one-time purchase for new patients and includes one initial psychiatric evaluation and four follow-up appointments. Eligible new self-pay patients may purchase Flex Intake for $179 under the Year-End Care Event, subject to the published promotional conditions through December 31, 2026. The Nureli Flex Continuing Care Package is a $199 one-time prepaid purchase for eligible established patients and includes four psychiatric follow-up appointments. Included follow-up visits in both packages have no fixed expiration date. Follow-up timing and frequency are determined by the treating clinician's professional judgment, clinical necessity, and appointment availability. Neither package guarantees appointments on demand or specific prescriptions.
Both packages are one-time purchases only, with no automatic renewal or recurring billing. Patients must actively purchase another eligible Continuing Care Package when additional visits are needed, or arrange individual pay-per-visit follow-up appointments at $50 each.
Refund requests for either Flex package must be submitted by secure message through the Healthie patient portal, and Nureli manually processes refunds and confirms the outcome through secure portal messaging. Package pricing, included visits, and the equal-value prorated refund calculation are published in the Financial Policy section of Nureli's Terms of Service at https://nureli.health/terms and are disclosed before purchase. Once a refund is issued, the corresponding unused visits are no longer available. Nothing in these package terms limits refunds or remedies required by applicable law.
Participation in Nureli Flex does not guarantee indefinite psychiatric treatment, medication prescriptions, or ongoing services beyond the benefits of the applicable package. Patients who wish to continue treatment after using their included visits may actively purchase another eligible Continuing Care Package or arrange follow-up appointments through Nureli's standard pay-per-visit option.
If a patient does not purchase additional eligible visits and does not arrange continued care through pay-per-visit appointments, Nureli will not automatically schedule or provide additional routine appointments or package services. The patient's care may become inactive and the professional treatment relationship may be formally concluded in accordance with applicable state laws, clinical standards, and Nureli's discharge procedures. Completing a package or receiving a refund does not, by itself, automatically terminate the clinician–patient relationship or eliminate legally required continuity-of-care obligations.
Patients are encouraged to arrange continued treatment before their included visits are used to avoid interruptions in psychiatric care or medication management. Prescription renewals remain subject to clinical assessment, applicable prescribing requirements, and appropriate follow-up. Any formal termination of care will follow applicable notice, referral, and transition-of-care requirements.
5. Telehealth Technology and Privacy Safeguards.
Nureli provides psychiatric care through secure telehealth technology and uses a HIPAA-compliant electronic medical record system for clinical documentation and patient information. Video visits are conducted using Zoom configured for healthcare use with appropriate HIPAA safeguards. Nureli maintains administrative, technical, and organizational safeguards to protect patient information. Telehealth communications may involve the electronic transmission of protected health information, and despite reasonable safeguards, no electronic system is entirely free of privacy or security risks. Patients should participate in telehealth visits from a private location and use a secure internet connection when possible.
6. Limitations of Telehealth.
Telehealth does not permit every component of an in-person examination. Technical interruptions, connectivity failures, or audio and video limitations may affect care. Some conditions may require in-person assessment, laboratory testing, emergency evaluation, or referral to another provider or setting. The treating clinician determines whether telehealth is clinically appropriate for each patient, and if telehealth is not appropriate, Nureli may recommend another provider or setting.
7. Patient Identity and Location Verification.
Nureli requires identity verification before routine psychiatric services begin. Patients must upload an acceptable government-issued photo identification document through Nureli's approved secure intake process, and the identification must reasonably match the legal name, date of birth, and identity information maintained in the patient's electronic medical record. Required identification documentation must be maintained in the patient record throughout treatment, and patients must participate in additional identity verification when reasonably requested. Expired identification may be accepted for routine identity verification when sufficient to establish identity, unless applicable law or another applicable requirement mandates current identification. Patients may be asked to verify their identity before or during telehealth encounters. When identity verification cannot be completed during a telephone encounter, the patient may be required to transition to a video encounter for visual verification. If identity cannot be established, the encounter may be postponed or rescheduled, and Nureli may be unable to proceed with nonemergency services until verification is completed. Patients who cannot reasonably obtain or present standard identification may request an alternative verification or accommodation review, which Nureli will consider consistent with applicable law. Patients must provide their current physical location at the time of each visit, including the state where they are located, so that Nureli may confirm the treating clinician is authorized to provide services in that state. Patients must promptly disclose any change in their location. Appointments may need to be rescheduled if a patient is physically located in a state where the clinician is not authorized to practice.
8. Information Sharing, Confidentiality, and Medical Records.
Clinical information is documented and maintained in Nureli's electronic medical record. Protected health information is used and disclosed for treatment, payment, healthcare operations, and other purposes permitted or required by law, and additional patient authorization will be obtained when legally required. Patients may request access to their medical records in accordance with applicable law. Nureli's Notice of Privacy Practices provides additional details about privacy rights and information-sharing practices.
9. Emergency Situations.
As stated in Section 2, Nureli does not provide emergency medical or psychiatric services. Patient portal messages and routine scheduling channels must not be used for emergencies. Patients experiencing an immediate emergency should call 911 or visit the nearest emergency department, and individuals experiencing a mental health crisis may call or text 988. The treating clinician may recommend emergency or in-person services when clinically necessary.
10. Telehealth Recording Prohibition.
Clients are strictly prohibited from audio recording, video recording, screen recording, livestreaming, or otherwise capturing or reproducing any portion of a telehealth appointment with Nureli Medical Group.
Recording Policy and Acknowledgment
This prohibition applies at all times, regardless of whether the treating clinician has provided verbal or written consent. Clinicians are not authorized to grant exceptions to this policy.
The prohibition includes recordings made through smartphones, computers, third-party applications, external recording devices, or any other technology.
Violations may result in administrative discharge, subject to applicable law, clinical review, and continuity-of-care obligations.
Nothing in this provision limits rights that cannot lawfully be restricted, including applicable disability accommodations, legally protected documentation or reporting activities, or other rights established by law.
This policy applies to all Nureli telehealth appointments, regardless of payment method or treating clinician.
I acknowledge that Nureli's Telehealth Recording Prohibition applies to all Nureli telehealth appointments, regardless of payment method or treating clinician. I understand that I must not audio record, video record, screen record, livestream, or otherwise capture or reproduce any portion of an appointment, even if the treating clinician provides verbal or written consent, and that clinicians are not authorized to grant exceptions. This acknowledgment does not limit rights that cannot lawfully be restricted, including applicable disability accommodations, legally protected documentation or reporting activities, or other rights established by law.