I understand that telemedicine or telehealth is the use of electronic information and communication technologies by a health care provider to deliver services to an individual when he/she is located at a different site than the provider.
I understand that telemedicine or telehealth visits are reserved for mild to moderate medications and may not be appropriate for severe or life-threatening illnesses.
I understand that medical evaluation, diagnosis and treatment offered on CallonDoc.com are virtual or asynchronous in the absence of a face to face physical examination.
I agree to follow up with a doctor in-person or seek emergency care after a telemedicine for further evaluation of your condition or sooner if symptoms do not improve or resolve in a timely manner.
I agree to call 911 or seek emergency care if your symptoms or condition worsen or immediate medical is required after your telemedicine visit.
I agree to continue the recommended routine physical visit with an in-person physician while utilizing telemedicine as secondary means of accessing healthcare.
I certify that I do not have any cognitive impairment and capable of making sound medical decisions.
I understand that I'm engaging in telemedicine (telehealth) consultation and I accept the risk of misdiagnoses due to the absence of in-person evaluation or diagnostic tools.
I certify that I must be an adult patient or an adult legal guardian of a minor patient to use the Callondoc.com platform.
I understand that services rendered by Callondoc are provided on a non-refundable basis.
I understand that my payment to Callondoc.com, the consultation fee, may not cover the prescribed medication and I still have to pay for the prescribe medication at the pharmacy.
I understand that the information given on the medical intake form must be complete, accurate and up-to-date to the best of my knowledge.
I understand that my failure to provide a complete, accurate and truthful information on the intake form puts me at a harmful risk of misdiagnosis and incomplete treatment.
I understand that Callondoc reserves the right to decline treatment if misleading pieces of information are given by the patient or user.
I hereby acknowledge that providing my personal information to Callondoc.com is voluntary, and is required as a personal identifier to deliver. medical services.
Call-On-Doc respects patient privacy by requesting Informed Consent Authorization (ICA). This informs patients that some of their health information “may” be used for marketing purposes such as age or gender, but still will request for their consent.
I understand that I am establishing a Provider-Patient relationship via telemedicine and/or telehealth. That I have read or had this form read and/or had this form explained to me, and I fully agree with the contents. That I fully understand and agree with its contents including the risks and benefits of telemedicine. That I have been given ample opportunity to ask questions and that any questions have been answered to your satisfaction.