Dr Tess of Beverly Hills/Virtual Concierge MD
Theressia L. Washington, MD, P.C.
Version 2026.3 | Effective September 2, 2026
You are requesting medical care by telehealth from Theressia L. Washington, MD, a physician board certified in Family Medicine and licensed in California, Illinois, Indiana, Montana, Nevada, and New York. Her National Provider Identifier and state license numbers are available on request.
Telehealth is the delivery of health care, diagnosis, consultation, treatment, and education using interactive audio, video, and electronic communication technologies when you and your physician are in different locations.
Your care may include live video visits, telephone (audio-only) visits, secure messaging, review of photographs or documents you upload, review of your medical history and medications, ordering of medications, laboratory testing, or imaging, and remote monitoring where appropriate. All visits are documented in a secure electronic health record.
If you believe you are experiencing a medical emergency, call 911 immediately or go to the nearest emergency room.
Telehealth is not appropriate for chest pain, shortness of breath, severe bleeding, suspected stroke, severe allergic reaction, serious injury, thoughts of harming yourself or others, or any condition requiring immediate hands-on evaluation.
If you are in emotional crisis or having thoughts of suicide or self-harm, call or text 988 to reach the Suicide and Crisis Lifeline, or call 911.
Do not participate in a telehealth visit while driving or doing anything else unsafe.
Telehealth can provide faster access to care without travel, care from your home or workplace, convenient follow-up and medication management, continuity of care when in-person visits are impractical, and reduced exposure to contagious illness.
You should understand that:
You are responsible for having a device with a working camera and microphone, a reliable internet connection, and a private location for your visit. Your physician may end or reschedule a visit if the technical quality is inadequate for safe care, or convert a video visit to another format.
I consent to receive care by the following methods (select all that apply):
Important audio-only limitations. Audio-only visits are appropriate only for certain concerns and are not suitable when visual assessment is clinically necessary. Indiana does not recognize audio-only communication as telehealth for most purposes, so patients located in Indiana will generally require video. Audio-only visits may not be used to prescribe controlled substances. Your consent to audio-only care is documented separately here and remains valid for up to twelve months unless you withdraw it.
You must confirm your physical location at the beginning of every visit. The law of the state where you are physically located at the time of service governs your care, and your physician can treat you only if she is licensed in that state.
Tell us before your visit if you have moved or are traveling. If you are located outside California, Illinois, Indiana, Montana, Nevada, or New York, your visit cannot proceed and will be rescheduled or refunded.
Your care is delivered using HIPAA-compliant technology with encryption in transit and at rest, and access to your electronic protected health information is restricted to authorized personnel.
Your health information may be shared with pharmacies, laboratories, and other providers involved in your care, consistent with our Notice of Privacy Practices, which you have the right to receive and review.
You will be told if any additional person is present on our end of the visit, and you may ask that anyone not necessary to your care be excluded from your side as well.
Substance use disorder records. If your record includes substance use disorder treatment information protected by federal law at 42 CFR Part 2, that information carries additional protections. Under the current federal framework, a single written consent from you may authorize disclosure for treatment, payment, and health care operations, and you may revoke that consent in writing at any time. Part 2 records generally may not be used against you in legal proceedings without your consent or a court order.
Nevada residents. Health data collected outside the HIPAA context is subject to Nevada's consumer health data privacy law. See our Consumer Health Data Privacy Notice.
Where generative artificial intelligence is used to draft a patient communication containing clinical information that is not reviewed by a licensed clinician before it is sent, that communication will be clearly labeled as AI-generated and will tell you how to reach a human member of the clinical team.
Artificial intelligence is never used to make clinical decisions, to generate your treatment plan, or to provide therapy. All clinical judgment in your care is exercised by Dr. Washington.
Under the DEA's fourth temporary extension of telemedicine flexibilities, DEA-registered practitioners may prescribe Schedule II–V controlled substances by telehealth without a prior in-person examination through December 31, 2026, provided the prescription is for a legitimate medical purpose in the usual course of practice, complies with the law of both the practitioner's and the patient's states, and is issued using two-way audio-video technology.
A permanent DEA rule governing telemedicine prescribing is pending. We will notify affected patients of any change that affects their treatment.
If controlled substances are prescribed for you, additional requirements apply, including a separate Controlled Substance Agreement, prescription drug monitoring program review, and possible drug screening or in-person evaluation. Your physician may decline to prescribe any controlled substance when it is not clinically or ethically appropriate.
This is a cash-pay practice. We do not bill insurance. Payment is due at the time of service. Medications, laboratory testing, imaging, and supplements are billed separately by the pharmacy, laboratory, or vendor and are not included in your visit fee.
As a self-pay patient, you have the right to receive a Good Faith Estimate of expected charges before scheduled services. Ask us for one at any time, and see our Good Faith Estimate notice.
You have the right to withdraw this consent at any time without affecting your ability to receive future care; to request an in-person visit instead of telehealth; to the same professional standard of care you would receive in person; to privacy and confidentiality of your information; to access your medical records; to ask questions about the telehealth process at any time; to free language assistance and interpretation, including ASL, on request before or during your visit; and to decline the presence of any family member, caregiver, or other participant in your visit.
You agree to provide accurate and complete information about your health history, symptoms, medications, supplements, and substance use; to confirm your physical location at each visit; to be in a private, safe location; to follow treatment and medication instructions; to seek emergency care when needed; to arrange recommended follow-up; and to tell your physician promptly about side effects or changes in your condition.
You may instead see your primary care physician in person, visit an urgent care center, see a specialist in person, or go to an emergency room for urgent conditions. Choosing telehealth is voluntary.
By signing, I acknowledge that:
Patient name: _______________ Date of birth: _______________
Signature: _______________ Date: _______________
If the patient is a minor: I am the parent or legal guardian of the patient named above and I consent to their care under these terms.
Guardian name: _______________ Relationship: _______________
Signature: _______________ Date: _______________