Online Consultation Consent Form
- I understand and confirm that I agree that the doctor may engage via a telehealth consultation with me.
- I understand that the consultation will be done via video/internet conferencing technology.
- The purpose of the telehealth consultation is to assess and treat my condition, subject to the information provided by me.
- The telehealth consultation is done through a two-way video link-up whereby the practitioner can see the patient’s image/s on the screen and hear his/her voice.
- The consultation will take an average of 15-20 minutes but the patient may at any time ask that the telehealth consultation be stopped.
- I acknowledge the risks of telehealth consultation in respect of the technology use or assessment made by the practitioner when vital information regarding the problem is not disclosed by me
- Any paperwork exchanged will likely be provided through electronic means.
- During the telehealth and/or telemedicine consultation, details of my medical history and personal health information will be discussed through the use of interactive video.
- Any advice and/or prescription of medication will be in accordance with the SAHPRA and AHPCSA guidelines.
- I take full responsibility to settle the consultation fee in full prior to the start of the online consultation process and proof thereof to be sent through to the practice.
- I understand and agree that the consultation may be recorded.
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