Consent to Treatment with Telemedicine
By signing this form, you agree that you have read, understand, and agree with these terms if scheduled for a telemedicine appointment. By signing below, I acknowledge the following:
I am aware of the provider that I am scheduled to have my telemedicine appointment with.
I have been able to ask questions about telemedicine sessions with GPS staff.
I am aware that I can reach out to the office if I have any questions.
I understand that no guarantees have been made about the success or outcome, and I agree to take part in a telemedicine appointment.
I understand that the telemedicine consultation will be similar to a routine medical office visit.
I understand that this is an option on a temporary basis due to the COVID-19 Pandemic.