Consent to Telehealth

By checking the “Agree” box you accept this Consent to Telehealth, and you acknowledge your understanding and agreement to the following:

 I understand that I cannot obtain emergency care through the Services.

 I understand, if emergency care is needed, I should call 9-1-1 and seek immediate medical treatment if I am experiencing a medical emergency.

 I give my informed consent to receive medical care and treatment by telehealth from Providers.

 I understand that the delivery of health care services via telehealth is an evolving field and that the use of telehealth in my medical care and treatment may include uses of technology not specifically described in this consent.

 I understand that a technical failure affecting the Services may result in the loss of my information and/or interrupt my online visit. In addition to any disclaimers that I agreed to by accepting the Terms of Use, I agree to hold company harmless for any loss of information or delay in care resulting from a technical failure.

 I understand that while the use of telehealth may provide benefits to me, as with any medical care service no such benefits or results can be, or are, guaranteed.

 I understand that my condition may not be improved and/or cured, and in some cases, may get worse.

 I understand that I have a duty to answer questions about my health and medical history honestly and accurately, and to keep all my health care providers, including my Provider, up to date on any changes in my health, symptoms, treatments, or medications.

 I understand that withholding or providing inaccurate information about my health and medical history to obtain treatment may result in harm to me, including, in some cases death.

 I understand that I have access to all my health and wellness information pertaining to my telehealth consultation with my Provider in accordance with applicable laws and regulations applicable to my jurisdiction.

 I understand that my Provider may determine in his or her sole discretion that my condition is not suitable for treatment using telehealth, and that I may need to seek medical care and treatment in person or from an alternative source.

 I understand that the Services enable coordination and communication with a Provider and do not replace my relationship with any existing health care provider.

 I understand that my information, including my identified health information, will be collected, used, shared, and protected as described in the Privacy Policy.

 I understand that if applicable, my Provider, will share my telehealth record with my other health care providers only with my consent and at my request. I understand that I can have my telehealth record sent to my other health care providers by emailing my Provider and providing my consent along with my health care provider’s name, address and phone number.

I understand that I can withhold or withdraw this consent at any time by emailing Total Skin and Wellness Med Spa LLC at schedule@totalskinandwellness.com Otherwise, this consent will be considered renewed upon each new telehealth consultation with a Provider. I have carefully read this Consent to Telehealth and understand the risks and benefits of the use of telehealth in my medical care and treatment.

I agree and authorize Total Skin and Wellness Med Spa LLC and my Providers to collect, use, and share my information, including my identified health information and other information regarding the telehealth exam, as described in Privacy Policy and for any other purposes permitted by law, including for treatment, payment, and health care operations purposes. All capitalized terms used in this Consent to Telehealth but not defined herein have the meanings assigned to them in the Terms of Use and/or the Privacy Policy.