Telemedicine/Telehealth Consent Form

$149.00

SKU: 2009 Categories: ,

Telemedicine/Telehealth Consent Form

This form outlines the terms and conditions for participating in a telehealth consultation through the Company.

Key Points:

  • Telehealth: You agree to engage in a virtual consultation with a healthcare practitioner via video or telephone.
  • Identity Verification: You may be required to provide identification documents.
  • Privacy and Security: While reasonable measures will be taken to ensure confidentiality, you acknowledge the risks of potential breaches and waive confidentiality in certain situations.
  • Risks and Limitations: You understand the potential risks and limitations of telehealth, such as technical failures and incomplete consultations.
  • Alternative Options: You acknowledge that you can seek in-person consultation instead.
  • No Compensation: You will not receive compensation for participating in telehealth sessions.
  • Release of Liability: You release the Company from any liability arising from the telehealth consultation.
  • Communication Interruptions: Procedures for addressing technical issues during sessions are outlined.
  • Email and Text Messages: These will be used solely for scheduling purposes and not for discussing health issues.
  • Audio and Video Recordings: Sessions will not be recorded without written consent from both parties.
  • Consent to Treatment: You voluntarily agree to receive telehealth services and authorize the Company to provide necessary care.
  • Discontinuing Telehealth: Either you or the Company can decide to discontinue telehealth services if deemed appropriate.

By signing this form, you acknowledge that you have read and understood the terms and agree to participate in telehealth consultations under these conditions.

Telemedicine/Telehealth Consent Form

This form outlines the terms and conditions for participating in a telehealth consultation through the Company.

Key Points:

  • Telehealth: You agree to engage in a virtual consultation with a healthcare practitioner via video or telephone.
  • Identity Verification: You may be required to provide identification documents.
  • Privacy and Security: While reasonable measures will be taken to ensure confidentiality, you acknowledge the risks of potential breaches and waive confidentiality in certain situations.
  • Risks and Limitations: You understand the potential risks and limitations of telehealth, such as technical failures and incomplete consultations.
  • Alternative Options: You acknowledge that you can seek in-person consultation instead.
  • No Compensation: You will not receive compensation for participating in telehealth sessions.
  • Release of Liability: You release the Company from any liability arising from the telehealth consultation.
  • Communication Interruptions: Procedures for addressing technical issues during sessions are outlined.
  • Email and Text Messages: These will be used solely for scheduling purposes and not for discussing health issues.
  • Audio and Video Recordings: Sessions will not be recorded without written consent from both parties.
  • Consent to Treatment: You voluntarily agree to receive telehealth services and authorize the Company to provide necessary care.
  • Discontinuing Telehealth: Either you or the Company can decide to discontinue telehealth services if deemed appropriate.

By signing this form, you acknowledge that you have read and understood the terms and agree to participate in telehealth consultations under these conditions.