Telehealth Consent

Last updated: [DATE]

DRAFT - pending legal review. Not final.

What telehealth is

Telehealth lets you get care from a licensed provider through secure online forms, messaging, phone or video instead of an in-person visit.

Benefits and limits

Telehealth is convenient, but your provider cannot do a physical exam and may decide in-person care is better for you.

Your responsibilities

You agree to share complete, truthful information, follow your provider’s instructions, and seek in-person or emergency care when needed.

Privacy and security

We use secure systems to send your information, though no electronic system is completely risk-free.

Your consent

By continuing, you agree to receive care through telehealth. You can withdraw consent at any time. [STATE-SPECIFIC LANGUAGE FROM PARTNER]

⚠ If you are experiencing a medical emergency, please call 911 or visit the nearest emergency room immediately.

ShiftPoint Health

Doctor-led medical weight care.

Phone: [US PHONE NUMBER]

Email: support@shiftpointhealth.com

Mail: ShiftPoint Health LLC, [STREET ADDRESS], [CITY, STATE ZIP]

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Medical services are provided by [NAME OF PC], an independent medical group, not ShiftPoint Health. ShiftPoint Health LLC provides administrative and management support services and does not practice medicine. Prescriptions are issued only when a licensed provider determines treatment is appropriate and are filled by state-licensed pharmacies. Individual results vary.

Compounded drugs are prepared by state-licensed pharmacies. They are not reviewed or approved by the FDA for safety, efficacy, or quality.

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