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Telehealth

Pediatric Surgical Associates is happy to be offering Telehealth as a safe alternative to clinic visits during this difficult time.

Please follow the directions closely in preparation for your Telehealth appointment. These instructions are important to ensure your appointment runs smoothly and without technical difficulties.

 

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Complete your Forms Online:

 

Virtual Visit Consent Form – For Telehealth appointments only

Virtual Visit Consent Form

 

Patient Information & Demographic Form – New patients or returning patients not seen in previous 12 months

Submit Online

(Printable PDF)

 

HIPAA Privacy Consent Form – New Patients

Submit Online

(Printable PDF)

 

Health History Form – For all new patients or returning patients not seen in previous 12 months

Submit Online (Requires Patient Portal account. If you don’t have an account, refer to alternate version)

(Alternate Version)

 

Prenatal Health History Form- For patients having a Prenatal consult

Submit Online

*Only use this form if your first appointment is a prenatal consult. If this applies to you, you do not need to complete the Health History Form listed above.

(Printable PDF)

 

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Connecting to the Appointment:

You will receive a text message 30 minutes before your scheduled appointment time with a direct link to join the appointment.

 

IMPORTANT: Please follow these tips at the time of your appointment to ensure there are no connectivity issues.
  • It is very important that you have a strong Wi-Fi connection in your home.
  • Please be physically located near your wireless router, or wherever in your home has the best connection.
  • Make sure your smartphone is connected to Wi-Fi,
  • Close out all other phone apps.
  • Make sure your smartphone is NOT in “low power mode”. Phone needs to have 50% of higher battery life to ensure best connection.
  • Make sure your phone’s web browser setting allow access to camera and microphone

 

Alternate way to connect: Connecting from your Computer (please ensure you have a quality webcam)

  • Login to your Patient Portal account 15 minutes before your appointment. Once logged in, you will see where to join the appointment on the home page.

 

Note: You must be available for you appointment 30 minutes prior to your scheduled appointment time and one hour after scheduled appointment time. Your provider will try their best to be available at their scheduled appointment time. However, there may be times this does not happen. If you have not heard from your provider during this timeframe, please then contact the Telehealth specialist whose number is 612-813-8023. There may be times we are ahead of schedule and may call to have you logon prior to your scheduled appointment time. This is why we want you available up to an hour before.

 

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Additional Information

  1. No-show policy: There is a lot of preparation done by our staff in preparation of each appointment. If you cancel an appointment with less than 24 hours’ notice, or fail to show up (connect), you will be charged for the appointment as follows:  New patients:  $250.00,  Follow-up patients: $150.00
  2. At this point we are NOT ordering radiology imaging for Televisits. If your provider deems if/when it  is necessary, during your Televisit,  they will instruct you further on obtaining images.
  3. At least 30 minutes prior to your visit you will get a call from our Medical Assistant to begin confirming vital information for your appointment. Please ensure you do not miss this call (This may appear from a “blocked number”).

 

Please note, Your child MUST be present for the appointment.

 

                       


Pediatric Surgical Associates





Related Sites

Children's Hospitals and Clinics of Minnesota
American Urological Association
American Pediatric Surgical Association
American Academy of Pediatrics
Midwest Fetal Care Center
Gillette Children's Specialty Healthcare
Regions Hospital
Twin Cities Shriners Hospital
APSA Parent and Family Resource Center
Urology Care Foundation Patient Education

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