TELEMEDICINE CONSENT FORM
Our federal government has passed an emergency resolution authorizing Telemedicine visits during the Covid-19 pandemic. Many medical problems can be managed safely and efficiently with a Skype or phone conversation. During the pandemic this is the safest method for a visit for the patient and the Clinic Staff.
I understand and agree to the following:
- The registration and preparation of your chart are the same as an on-site visit.
- The visit will be record in your medical record labeled as a telemedicine visit.
- You may be required to come to the Clinic or directed to a laboratory for additional testing or examination.
- There is a charge for the visit: copay’s and deductibles will apply and be collected by on-line credit card payments.