Informed Consent for Virtual Service for The Fitness Fix Inc

In light of COVID-19, The Fitness Fix Inc. is following the directives by the Alberta government, Public Health and the Ministry of Health. In this regard, The Fitness Fix Inc. is starting to offer virtual care in an effort to try to continue to care for our clients safely and effectively. This means that we will be using the following technology to provide services: Skype, Zoom, and/or Facebook (the “Technology”).
Some health concerns can be addressed with services via the Technology, but in some cases it may not be possible. In the event a physical Assessment is necessary or in an emergency, you will be required to visit a hospital or other health care facility.
Before proceeding, you should understand that services via the Technology is not a substitute for in-person communication or clinical assessments.
The Fitness Fix Inc. offers virtual kinesiology sessions/appointments via the Technology (the “Services”). The Services are available to clients who are unable to attend in-person sessions, either in a clinic or community setting. Clients must meet specific criteria to utilize the Services and those will be discussed with you. Before I/we can provide the Services, we need to make sure you are aware of the potential risks of this type of appointment/session and agree to assume these risks.
Potential Risks of the Services include, but may not be limited for the following:
• Reduced ability to accurately assess your physical function, strength, cardiovascular fitness, flexibility or other movement patterns compared to in-person service.
• Reduced ability to recognize faulty or incorrect exercise posture or movements, due to camera viewing angle, clarity of image, size of image, visual artifacts, two-dimensional viewing, ability to move around and view from multiple angles, along with others.
• The security of the Technology cannot be guaranteed; however, every effort is made to ensure your session cannot be intercepted or otherwise accessed by unknown person(s) or entities on the internet. We utilize a platform that we understand to be complaint with privacy and confidentiality requirements, including the Health Information Act (HIA). Further information about the platform’s security measures are available upon request.
• Your internet connection may be subject to unauthorized interception if it is not securely encrypted, you are accessing from an open wi-fi network, either in your home or outside of your home, such as a coffee shop. To maintain your personal privacy, you should ensure that your internet connection is secure and you are not utilizing an open wi-fi system, in order to prevent unintended access by others to any session(s) between yourself and the kinesiologist.
• Hardware, including computers, tablets, laptops and cellular phones have inherent risks to infection from computer viruses, malware or applications which record and spy on your device usage. To prevent this exposure, you should only install trusted applications, install spyware/malware detection software on your device, utilize a firewall and a VPN to reduce the risks.
• Video conferencing systems may retain information of video or teleconference session(s) between the kinesiologist and yourself (the client) outside of Canada, which means that foreign laws may apply to any of the recorded information.
• Other risks of utilizing the Services include:
o Equipment failure
o Internet service failure/disruption (either party)
o Delay or failure to receive necessary healthcare due to equipment failure or internet disruption
The reasonable alternative(s) to using the Services are:
• In-person (face-to-face) appointments/sessions (when possible)
• Telephone appointments/sessions (when suitable)
I Acknowledge and Understand that:
• The Fitness Fix Inc. cannot guarantee the security of the information shared over the Technology.
• I have the right to withdraw my consent to the Services at any time, but that this consent is not retroactive to previous video/teleconferencing treatment/sessions. I understand that my withdrawal of consent will not affect my future care or treatment.
• The Fitness Fix Inc. may withdraw use of the Technology gat any time, should the security of the Technology come into question or for any other reasons.
• If for any reason the Technology is not suitable, becomes unsuitable due to safety or other concerns, for my treatment due to elevated risk of injury, complications or any other reason, based on the opinion of the kinesiologist, I agree to discuss and make arrangements to attend in-person sessions with The Fitness Fix Inc. or another healthcare provider of my choosing.
• All legislative and requirements of the College of Kinesiologists of Alberta apply to the Services
• The Fitness Fix Inc. will inform me if any other known person will participate or can hear or see any part of our session before the session begins.
• I am responsible for making sure my devices, phone, tablet, or computer - have up to date software to allow for the Technology.

• I have read and understand the information provided above regarding the Services and the Technology. I have been provided the opportunity to discuss the potential risks and ask questions, and all my questions and concerns have been answered to my satisfaction.
• By providing my information, I agree to allow The Fitness Fix Inc. to collect, use, or disclose personal health information through the Technology (while following applicable privacy laws) to provide me with care.
• I hereby give freely my informed consent for The Fitness Fix Inc. to utilize the Technology as a part of my care and treatment.
• I understand that my consent may be amended or revoked in whole or in part at any time by providing written notice to the kinesiologist as detailed in The Fitness Fix Inc. privacy Policy, which is available I have had the opportunity to view.