Telehealth Consent Form

Health Car Services

  • I hereby authorize Health Care Services to use the telehealth practice platform for telecommunication for evaluating, testing, and diagnosing my medical condition.
  • I understand the technical difficulties may occur before or during the telehealth sessions and my appointment cannot be started or ended as intended.
  • I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.
  • I understand I am responsible for any fees for services rendered
  • I agree that my medical records on telehealth can be kept for further evaluation, analysis, and documentation, and in all of these, my information will be kept private.
  • Refund Policy: Our consultation fee is non-refundable once you have been connected with the provider and terms of service agreed.
  • Important: We do NOT prescribe dangerous drugs including narcotics, or any other controlled substances.

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