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Telehealth Consent & Services
Name
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Surname
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Date of birth
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Place of birth
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Email
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Phone number
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Medical Consent
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Please read and accept all the statements below.
Terms and conditions
I acknowledge that telehealth has inherent limitations compared to an in-person visit, including potential restrictions in the physical examination and diagnostic accuracy. I hereby consent to a telehealth medical consultation, understanding that this consultation will be conducted remotely via audio and/or video technology. I agree to provide complete and accurate medical information to the healthcare provider to facilitate appropriate care. I understand that the medical advice provided is based solely on the information I share and may not substitute an in-person consultation or emergency care. In case of urgent medical needs, I commit to seeking immediate in-person assistance or emergency services. I also consent to the processing of my personal and health data according to applicable data protection regulations, and I agree with the privacy policy and terms and conditions of the services.
Signature
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Signature
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