Consent for Telemedicine Services

I hereby provide my consent for telemedicine services with a Helecho Health practitioner. I acknowledge that telemedicine includes the provision of healthcare diagnosis, consultation, treatment, transfer of medical data, and education through interactive audio, video, or data communications. I understand that my medical information will be communicated orally and visually to healthcare practitioners and that the laws protecting the confidentiality of my medical information apply to telemedicine.

I am aware of the potential risks and consequences associated with telemedicine, including the possibility of technical failures disrupting or distorting the transmission of my medical information and unauthorized access to my electronic medical information. Additionally, I understand that telemedicine-based services may not be as comprehensive as face-to-face services. If my provider determines that I would benefit more from face-to-face medical services, they will refer me to an appropriate provider.

I accept that there are potential risks and benefits associated with any form of medical treatment, and that telemedicine may not guarantee the improvement of my condition. Therefore, I am aware that my provider cannot assume responsibility for my continued medical care or treatment.

I acknowledge that a telemedicine visit/encounter is not a replacement for an in-person doctor's visit. I understand and agree that I am proceeding with this telemedicine evaluation at my own risk and that in case of an emergency, I will contact local emergency response.

I certify that the information provided to Helecho Health is true and accurate to the best of my knowledge. I agree to disclose any pre-existing medical conditions or history honestly and openly with the practitioner assigned to assist me. I understand that omitting medical information or providing inaccurate information may result in an inaccurate diagnosis and treatment.

By responding to this service with proof of payment, I accept the terms and conditions of this consent and release Helecho Health and its practitioners of any and all errors and omissions, known or unknown, foreseen or unforeseen, knowingly or unknowingly. I acknowledge that Helecho Health has no liability or responsibility for the accuracy or completeness of the medical information submitted to them or for any errors in its electronic transmission.