Telehealth Consent AgreementTelehealth Consent Agreement • March 30th, 2020 • Massachusetts
Spine and Pain Institute of New England, PC (the "Practice") is a Massachusetts professional corporation located at 99 Longwater Circle, Suite 101, Norwell, Massachusetts 02061.
Televero Health, P.A.Telehealth Consent Agreement • May 16th, 2022
Televero Health, Inc. (“Televero”, the “Platform”) is a Delaware corporation headquartered at 6101 West Courtyard Drive, Austin, Texas 78730.
To our patients and families:Telehealth Consent Agreement • May 31st, 2017
Thank you for choosing us for your telehealth care. Patients and families are essential participants in health care and we want you to understand your rights and responsibilities while receiving care from us. If you have any questions about this form, please ask your provider. If you are a parent/legally-authorized representative of a child, please read this agreement with the understanding that “I” and “me” means the child.
Telehealth Consent AgreementTelehealth Consent Agreement • May 17th, 2016
Nicklaus Children's Health System, Inc. and its affiliates, including Variety Children’s Hospital d/b/a Nicklaus Children's Hospital, Pediatric Specialty Group, Inc. d/b/a Pediatric Specialists of America, Children's Health Ventures, Inc., and KidzStuff, Inc. (the "Health System") are Florida corporations with a location at 3100 SW 62nd Avenue, Miami, Florida 33155.
Telehealth ConsentTelehealth Consent Agreement • March 23rd, 2020
By signing this agreement, I understand that a medical exam and treatment will be provided through an interactive video connection. Electronic systems used will incorporate network and security protocols to protect the confidentiality of patient identification. No recording of the visit will be done but the visit will be documented in the medical record in the same way all visits are documented in the record.
Telehealth Consent – Page 1 of 2 Rev. 4/2020 To our clients and families: Thank you for choosing us for your telehealth care.Telehealth Consent Agreement • April 14th, 2020
Clients and families are essential participants in health care and we want you to understand your rights and responsibilities while receiving care from us. If you have any questions about this form, please ask your provider. If you are a parent/legally-authorized representative of a child, please read this agreement with the understanding that “I” and “me” means the child.
To our patients and families:Telehealth Consent Agreement • March 17th, 2020
Thank you for choosing us for your telehealth care. Patients and families are essential participants in health care and we want you to understand your rights and responsibilities while receiving care from us. By participating in telehealth care, you acknowledge you have read and agreed with our telehealth poIicies. If you have any questions about this form, plea se ask your provider. If you are a parent/legally-authorized representative of a child, please read this agreement with the understanding that “I” and “me” means the child.
Goodwin Community Health Telehealth- Virtual IOP Consent Agreements PageTelehealth Consent Agreement • December 3rd, 2020
MY TELEHEALTH CONSENT AGREEMENTTelehealth Consent Agreement • July 14th, 2020
• There are potential benefits and risks of video-conferencing (such as limits to client confidentiality that differ from in-person sessions.
Goodwin Community Health Telehealth- Virtual IOP Consent Agreements PageTelehealth Consent Agreement • December 3rd, 2020
