1. I understand that I will be providing any VA documents to Veteran Benefits Evaluations, LLC’s Health Care Professional team to see what options may be a good fit for me, refer me to additional services and resources if needed. The Health Care Professional cannot and will not provide any psychotherapy or evaluation services.
2. I understand that the main purpose of this service is to gather information about my mental health, physical, developmental and family history, history of my time in the military, and current concerns. The purpose of the intake is not to provide me with an Expert Medical Opinion , assist me with my disability benefit claims, and/or write or give any type of documentation to support a disability claim with the VA.
3. I understand that Veterans Benefits Evaluations, LLC does not guarantee service-connection or increase of any of my VA disability ratings using their services nor their website. The determination of VA disability benefits is made solely by the Department of Veterans Affairs and not by VBE. As such, VBE is not responsible and cannot be held liable for the VA disability benefits for which a Veteran may be eligible.
4. I understand that the Health Care Professional is NOT a licensed mental health professional and cannot provide me with any therapy, diagnosis, or advice beyond recommending particular therapist(s), services, and types of therapy.
5. I understand that the Health Care Professional is not affiliated with the VA. Any information shared with the Health Care Professional may only be shared with Veteran Benefits Evaluations. If I wish to share the information with anyone outside of these two agencies, I will sign a Release of Information (ROI).
6. I understand and allow the Health Care Professional to view my Private Health Information (PHI) to match me with the correct Health Care Professional within their network.

I understand that I will be meeting with an Independent Mental Healthcare Professional for an evaluation and possibly (if warranted) an Expert Medical Opinion. In meeting with this Mental Healthcare Professional, I understand that no medical treatments will be offered and that the Mental Healthcare Professional cannot provide prescriptions. The Mental Healthcare Professional is only completing an evaluation for me and offering their expert medical opinion (as warranted) for use in my disability claim. I am not considered a patient or client of this Mental Healthcare Professional and will not be provided medical treatment.

I understand that this service does not ensure any diagnosis or benefits. If there is insufficient medical evidence to support your claim, the opinion provided may be inconclusive or unfavorable. The Mental Healthcare Professional offers an expert medical opinion based on specific medical criteria as well as upon their years of training, education, and experience. This opinion may differ from VA raters or other medical professionals I have seen. The Healthcare Professional will not and cannot guarantee any kind of service connection or diagnosis. Although I may disagree with the Healthcare Professional’s opinion, it cannot be altered following the completion of our interview. I agree to accept the Healthcare Professional’s Expert Medical Opinion regardless of my feelings about their medical opinion. I agree to reschedule with a different Healthcare Professional if I feel that I need a second opinion and agree to pay the total cost of this second evaluation.

I understand that the Mental Healthcare Professional is a Licensed Independent Mental Healthcare Professional and will not make changes to my diagnosis or recommended service connection after this appointment because these items reflect their medical opinion as a Licensed Independent Medical Healthcare Professional. I cannot ask or expect a Healthcare Professional to make specific diagnoses that do not meet the appropriate medical criteria in the professional opinion of the Mental Healthcare Professional.

I understand that I will be meeting with a psychologist for an interview regarding my time in the military, as well as, my time since separating from the military. In meeting with this psychologist, I understand that no psychotherapy will be offered and that the psychologist cannot provide prescriptions. The psychologist is only completing an evaluation for me and offering no other services. I am not considered a patient or client of this psychologist. This exam aims to provide an evaluation for me to use for my claim with the VA for disability benefits.

I understand that the psychologist meeting with me is not providing a compensation and pension (C&P) exam, nor is the psychologist performing a disability evaluation as a certified VA evaluator when performing my evaluation.

I understand that VBE telehealth and any of its contractors are not affiliated with or contracted by the VA when providing evaluation services for VBE.

I agree that if the psychologist I see has additional contracts with the VA, then their opinions delivered as a psychologist under VBE telehealth do not reflect the opinions of the VA.

I agree not to contact the psychologist for a dual relationship such as friendship, advice, bartering, or other personal matters. I agree that I will not provide referrals or any other services for the psychologist that may be perceived as incentives for myself or others.

I understand that if there are factual errors in my medical opinion document (be spelling, incorrect dates, incorrect names), I should submit a ticket to the VBE helpdesk and that these corrections will be made.

I understand that if I am concerned about my interactions with a psychologist, I should speak with a VBE representative and send in a ticket through the VBE Help desk. I also understand that my concerns may not result in a refund or a pro-bono revaluation.

I understand that my medical records are held in a HIPAA compliant folder that is only visible to VBE and anyone I choose to share that information with. I agree to keep my health records in this folder.

I understand that I must provide a government-issued ID and my current location to the psychologist at the beginning of my appointment.

I also understand that if I state that I am considering ending my life, ending the life of someone else, have engaged in or know of a child, elder, or disabled adult abuse that the Healthcare Professional will contact local authorities, Child Protective Services, make an Elder Abuse claim, and/or call 911.

I understand that VBE is not a licensed physician but has access to a network of licensed independent contractor physicians, physician assistants, psychologists, or other Healthcare Professionals and professionals (each a “Contractor”) who are qualified to review medical records to assist the Service Healthcare Professional in preparing expert opinions, as necessary, for use by the Client in the VA benefits claims process.

I understand that the information gathered by the Healthcare Professional is my private Healthcare information and that it will not be released to anyone else except for under the following circumstances:

• I am in imminent danger of harming myself or another person. In this case, the Healthcare Professional will take whatever steps necessary to prevent harm.
• I share information that would lead a reasonable person to suspect that a child, disabled adult, or elderly adult is being abused or neglected. In this situation, the Healthcare Professional will contact the appropriate local agencies.
• I appeal my case to the Federal courts; some aspects of this exam could become a matter of public record.

I understand that meeting via telehealth and having my records held in an electronic folder carries some risk. I willingly agree to and understand that some of the risks are as follows:

• It is easier for electronic communication to be forwarded, intercepted, or even changed without my knowledge as a client, despite the psychologist and Veteran Benefits Evaluations taking reasonable measures to keep my information private.
• Electronic systems accessed by employers, friends, or others are not secure and should be avoided. It is essential for me to meet with my psychologist using a secure network.
• Despite reasonable efforts on the part of my healthcare psychologist, the transmission of medical information could be disrupted or distorted by technical failures.
• If a third party can breach my information, I do not hold my psychologist or Veteran Benefits Evaluations responsible for these instances and agree not to pursue legal action against either party if this occurs.

I understand that the risk of meeting via telehealth includes that others in my life and the Healthcare Professional’s life may overhear us and/or that myself or the Mental Healthcare Professional may be interrupted. The Mental Healthcare Professional will make reasonable efforts to keep our conversation private; however, I acknowledge and accept that there may be some risk of others hearing us interrupting our conversation. I will also make reasonable efforts to keep our conversation private.

I understand that with Telehealth, I may hear background information from where I am meeting with the Healthcare Professional and where the Healthcare Professional meets with me. I agree that this is acceptable.

I agree to meet with my Mental Healthcare Professional in a private space and not meet with my Healthcare Professional while driving. I also agree to wear appropriate clothing and understand that if I am in a state of undress or present inappropriately, my Healthcare Professional has the right to stop our interview. If I attend a second appointment in a similar state, I agree that I will not receive an evaluation and that I will not receive a refund.

I agree to attend our appointment sober and understand that if I come to our appointment inebriated in any way, the appointment will end, and I will not be issued a refund.

I understand that my psychologist may see veteran patients back-to-back and, as such, may be late for our appointment by up to ten minutes. If my psychologist is more than 10 minutes late, I agree to contact a VBE Specialist for assistance. I also understand that at times my psychologist may be handling a crisis situation and, thus, this would result in the rescheduling of my appointment. I agree to reschedule appointments in the event of an emergency for my psychologist and understand that someone from the Veteran Benefits Evaluations scheduling department will contact me to reschedule if needed.

I understand that my Healthcare Professional may have events occur in her or his life, leading to rescheduling our appointments such as family emergencies, and medical emergencies. If this occurs, I agree to reschedule and understand that someone from Veteran Benefits Evaluations’ scheduling team will contact me to reschedule.

I understand that I can end my Telehealth appointment at any time. I am not obligated to attend my appointment and am free to enter this appointment as I see fit. I understand that if I leave the appointment early, my medical Expert Medical Opinion may not be completed, which may result in not being service-connected. If I leave my appointment early, I agree that I will not receive a refund.

I understand that there are certain questions and information that the Healthcare Professional will need from me. At times, the Healthcare Professional may need to interrupt me to ensure that our time together is productive and all the information required for my medical Expert Medical Opinion is collected

I understand that although Veteran Benefits Evaluations utilizes a HIPAA-compliant platform, sometimes this platform may have difficulties. I agree to meet with my psychologist via telephone if necessary and agree to reschedule our appointment if telephone interviewing is not an option for me in my state.

I agree to submit any concerns through the proper channels (Help Desk/VBE Specialist) and not contact my psychologist through other means (finding their phone number online, social media, email, etc.).

If I have used any information from third-party sources such as and not limited to the internet, WebMD, social media, other veterans, other medical psychologists, etc. I understand that these sources are secondary opinions to the psychologist I meet with and do not guarantee a particular diagnosis. If I utilize notes or information from any third-party sources, I understand that this may affect my rating by the psychologist and the VA, and it is my personal choice to do so. I release the psychologist from any and all responsibility for my choice to utilize any third-party sources and understand that third parties are not affiliated with Veteran Benefits Evaluations.

I understand that any recommendations made by the psychologist are suggestions which I can choose to follow or not follow. It is my responsibility to pursue any recommended health care following the appointment. If I would like to receive healthcare treatment from the Veterans Health Administration, I may call any VA medical center or private clinic to request an appointment. The psychologist will not link me to health care.

I agree that if I have questions about this consent form, I will ask the psychologist on the day of my appointment. If their responses are not to my satisfaction, I agree to reschedule the appointment immediately. If I do not reschedule the appointment immediately, it means that I agree with and wholly understand and accept the risks and process involved in this evaluation.

I understand that I may have been referred to see my psychologist from a third party but that this third party is not affiliated with my psychologist as an independent contractor.

I understand that my psychologist will be unable to correct or change errors in my expert medical opinion after I have approved the written evaluation.

I agree to my private healthcare information (PHI) being shared and discussed with members of the Veteran Benefits Evaluations Team, if applicable. I also agree to sign a Release of Information (ROI) for any of the above to communicate with outside agencies, including the VA, my doctors, family members, and friends. If I do not sign an ROI, I understand that my psychologist cannot speak with any outside sources or agencies from Veteran Benefits Evaluations, contracted psychologists.

I understand that there are certain occupations wherein my diagnosis may affect my ability to retain my employment. I agree to find out if my occupation is one of these and to utilize my diagnosis accordingly. If I determine that my occupation would be affected by being service-connected, I understand that I will not be reimbursed for my evaluation.

I understand that Veterans Benefits Evaluations, LLC does not guarantee service-connection or increase of any of my VA disability ratings using their services nor their website. The determination of VA disability benefits is made solely by the Department of Veterans Affairs and not by VBE. As such, VBE is not responsible and cannot be held liable for the VA disability benefits for which a Veteran may be eligible. In fact, the VA may decrease benefits in some cases. Client understands that VBE makes no promises or representations as to what your case or claim will ultimately be worth. Thus, I understand and agree that I cannot hold VBE responsible for any decrease in benefits that may occur.