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Consent Forms

As You Are Consent Forms

In order for As You Are to provide telehealth services for your family, we’re required to have a number of consents on file. Below, are the individual consents that you will be asked to acknowledge when you schedule an appointment. If you would like a copy of your signed consent, please reach out to the support team at

HIPAA Notice of Privacy Practices

Informed Consent for Telehealth Services

Assignment of Benefits and Designation of Authorized Representative

Informed Consent for Electronic Communication

Financial Policy

Card on File Agreement

Virtual Care Registry Consent Form

Virtual Care Study Consent Form

Consent to Obtain PHI

Consent to Release PHI

Notice and Acknowledgement Regarding Medical Doctors in California

Minnesota Access to Health Records Notice of Rights

We Accept

Medicaid • TRICARE • Aetna • Cigna • CareSource • Blue Cross Blue Shield

Don’t see your health insurance provider listed? Don’t get discouraged! Coverage may vary by state and is based on each patient’s individual benefits plan. Our Support team is just a phone call away, 866.219.8595, and can confirm if your child’s individual health insurance plan is covered.

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Schedule an Initial Evaluation With Our Physicians Today.

It’s easy, and only takes a few minutes to start. We walk you through the entire process below. Not quite ready? That’s OK. We’re here and ready to answer all of your questions.

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