Informed consent to telerehabilitation

1. Parties and scope of acknowledgment

Service: StefanoniFisioLab. Practitioner and data controller: Valentina Stefanoni, physiotherapist registered with Ordine dei Fisioterapisti Interprovinciale Belluno, Treviso, Vicenza, Verona, no. 2216. Italian tax code (codice fiscale): STFVNT97L57M089S. VAT number (Partita IVA): 05054600266.

Email: stefanonifisiolab@gmail.com. Certified email (PEC): valentina.stefanoni01@pec.fnofi.it. Privacy contact: vale.stefanoni17797@gmail.com.

Format: online telerehabilitation. Tax domicile: Viale Virgilio 16, Vittorio Veneto (TV), Italy. Platform: Stefanoni FisioLab, with Google Calendar and Google Meet.

You identify yourself in the form using full name and email and book for yourself as an adult. Contact the practitioner first for minors or people assisted by a guardian. Clinical identification and any patient/guardian and practitioner signatures must be handled before care; the website checkboxes are not an authenticated digital signature.

2. Service, duration and fees

Telerehabilitation is rehabilitation delivered remotely through digital technology by a qualified healthcare professional. The practitioner must individually assess suitability and agree the goals of care.

This website books an initial assessment or follow-up video call. An individual plan, any home exercises, frequency and overall treatment duration are agreed during assessment, not automatically assigned by the website. It does not provide clinical questionnaires or exercise tracking.

First assessment: EUR 40; follow-up: EUR 30, for Valentina’s existing patients. Each appointment lasts 60 minutes. Payment is by bank transfer outside the website, following the practitioner’s instructions; invoicing is also handled outside the website. The website does not charge fees or automatically provide bank details. Weekday appointments are 14:00–21:00 Europe/Rome, with at least 24 hours’ notice and a 15-minute buffer.

3. Benefits, differences, risks and alternatives

Possible benefits include continuity without travel, exercising in your own environment and active participation. No particular outcome is guaranteed.

Remote care cannot provide palpation, manual therapy or tests requiring physical contact. Inadequate video, audio or framing can limit assessment.

Risks include falls, pain or fatigue during exercise, incomplete assessment, connection failures and communication-privacy risks. The practitioner may require in-person assessment or medical advice if remote care is unsuitable or unsafe. You may request an in-person alternative.

4. Requirements, safety and emergencies

Prepare a camera, microphone, up-to-date browser and stable connection. Join through Google Meet using the appointment link.

Use a private, well-lit space free of obstacles, comfortable clothes and, if requested, a stable chair or support. A support person may be needed if recommended. Tell the practitioner your current location and a reachable phone number at the start of the session; the booking form does not ask for these details.

Stop exercising and tell the practitioner if you experience unusual pain, dizziness, breathlessness or feeling unwell. Discuss relevant health changes during the consultation, not in booking emails.

The website is not an emergency service: call 112 in Italy/the EU or your local emergency number elsewhere. Do not use the website or email for urgent help. If the connection fails, contact the practitioner; agree how to resume or reschedule, without an unconfirmed promise of an automatic callback or a free replacement session.

5. Privacy, optional recordings and withdrawal

The privacy notice describes booking data and data processed in the professional relationship. The practitioner is bound by professional secrecy and explains clinical-information handling before collection.

Google Meet sessions may be recorded only with specific, explicit and separate patient consent, obtained and documented by the practitioner before recording starts. Before requesting consent, the purpose, recorded data, storage, access and recipients, retention period or criterion and withdrawal process must be explained. These details still need definition: no recording takes place until they are defined and disclosed. You may refuse and still receive an unrecorded session, or ask for recording to stop.

The three booking checkboxes do not authorize recording. The website does not collect this optional consent, start recordings or store audio/video files: the practitioner manages separate consent before the session or before recording starts. You may withdraw it by writing to vale.stefanoni17797@gmail.com; withdrawal does not affect earlier lawful processing, and requests concerning data already collected are handled under applicable rights and limits.

The website does not allow exercise-video uploads. Any materials provided separately by the patient or sharing with a doctor/caregiver require separate arrangements and authorizations where necessary. Recording consent does not automatically authorize AI, model training, research, marketing or public disclosure. Do not record or share the session without explicit agreement with the practitioner.

You may decline remote care, ask questions or withdraw your agreement at stefanonifisiolab@gmail.com. The practitioner must verify understanding and specific clinical consent before providing care. The private link lets you move or cancel before the start; a new time must meet the minimum notice period. Cancellation does not erase all data or withdraw every form of processing. Financial conditions must be clarified directly and are not automatically applied by the website.

6. Declarations and electronic acknowledgment

Before confirmation, the form presents three separate, initially unchecked boxes:

1. I agree to telerehabilitation after reading its risks, differences and limitations.

2. I acknowledge receiving and reading the privacy notice.

3. I commit to the safety instructions and to calling 112 in Italy/the EU or the local emergency number in an emergency.

You may ask the practitioner questions before agreeing. These declarations are not consent to recording or future AI tools; any recording consent is optional, separate and documented by the practitioner outside the form before recording.

These three declarations are recorded together on confirmation with booking identifier, date/time and version booking-legal-2026-10-06-fiscal-address. This documents your choice of remote care and does not replace identification and specific clinical informed consent verified by the practitioner.

Updated: 6 October 2026.