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Consent form for telemedicine consultation

I voluntarily choose to have a teleconsultation with the healthcare professional of my choice, and I am aware of the following:

This teleconsultation's objective is to evaluate and manage my medical condition. Using a two-way video link, the doctor or other healthcare professional can see my image on the screen and hear my voice during the telemedicine consultation. The doctor or other health professional does not have the use of other senses, like as touch or smell, unlike in a traditional medical consult, so it might not be comparable to a face-to-face visit.

The telemedicine specialists must rely on the information I or my onsite healthcare providers offer because they practise at a different place and cannot meet with me in person. Advice, suggestions, and/or decisions made based on erroneous or incomplete information supplied by me or others cannot be held against the healthcare provider or the platform. I have the ability to inquire about procedures and telemedicine technology clarification. I am aware that there could be hazards involved in using this technology. These consist of, but are not restricted to:

  • Disruption of the audio-visual connection
  • Cutting the audio/video connection
  • A photo that is too blurry to satisfy the consultation's requirements.
  • Electronic manipulation.

It might be necessary to halt the procedure if any of these hazards materialise. I agree to cover the consultation costs as well as any platform fees and other associated costs for the teleconsultation.

Medication Instructions

Please carefully follow these instructions for your prescribed medications:

  • Consume each medication with a full glass of water.
  • Take the prescribed dosage exactly as directed. Do not exceed the recommended dose.
  • If you have any doubts or questions about your condition or the medications, promptly consult your doctor.
  • Refrain from driving or operating machinery unless advised otherwise by your doctor. Avoid consuming alcohol while on these medications.
  • Report any side effects to your doctor promptly.
  • Do not substitute medications without consulting your doctor or pharmacist.

If you are unable to attend your scheduled session, please inform us at least 48 hours in advance to be eligible for a refund. In case of emergencies or unforeseen circumstances, please reach out to us as soon as possible to reschedule your appointment. Refunds are only applicable if you inform us at least 48 hours before the scheduled session. To reschedule your appointment, please inform us at least 24 hours before the scheduled session. Failure to do so will result in cancellation without refund or option to reschedule. I attest to having read the aforementioned, comprehending its contents, and giving my informed consent to receive medical advice via telemedicine.