Agreement to Use Telehealth Services

I consent Leanefy LLC to engage in a telehealth consultation with a medical professional for diagnosis, consultation, treatment, and patient care management.

The Type of Consultation in Telehealth

• Video conferencing will be used to conduct the consultation.
• The patient and the provider will not be in the same physical space.
• Real-time communication and electronic medical record transmission are two possible aspects of telehealth services.

Possible Dangers

• Technical malfunctions like problems with connectivity.
• Potential illegal access to health data.
• Limitations in diagnosis because of the online format.

Privacy and Secrecy

In accordance with HIPAA regulations, I understand that my private health information will be kept private. Unauthorized access is a risk that comes with telecommunication, though.

The Obligations of Patients

• Give a complete medical history and be honest when responding to all inquiries.
• For the consultation, make sure you have a steady internet connection.
• Make sure you have a legitimate government-issued ID on hand for validation.

Consent and Agreement

I hereby attest that I am aware of the nature of telehealth consultations, the associated risks, and my obligations. I give Leanefy LLC my consent to use their telehealth services. (We appreciate your consent to complete the Good Faith Exam and Medical History Form.)