TELEHEALTH CONSENT & OPEN PAYMENTS NOTICE

Last Updated: February 16th, 2025

INFORMED CONSENT FOR TELEHEALTH SERVICES

By clicking “I AGREE,” checking a related box, or otherwise accepting this consent electronically, you acknowledge that you have read, understood, and agreed to the terms outlined below. If you do not agree, do not create an account or use the telehealth services provided by Optimal T Clinic.

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EMERGENCY NOTICE

If you are experiencing a life-threatening emergency, call 911 or the 988 Suicide & Crisis Lifeline at 988 immediately. Telehealth is not appropriate for emergency situations.

 

WHAT IS TELEHEALTH?

Telehealth allows healthcare services to be delivered remotely using secure digital communication technologies. This may include:

• Video consultations

• Secure messaging or email communications

• Transmission of medical records, test results, or images

• Use of medical devices to monitor health data

Telehealth services at Optimal T Clinic may be provided by physicians, nurse practitioners, or physician assistants, depending on your specific needs.

 

BENEFITS OF TELEHEALTH

• Convenient access to care from anywhere

• Reduced travel time and costs

• Faster access to medical advice and follow-ups

 

POTENTIAL RISKS

While telehealth is a valuable healthcare tool, it does have limitations, including:

• Technology failures that could impact the quality of care

• Security risks associated with digital communication

• The inability to conduct certain physical exams or diagnostic tests remotely

• The potential for delays in diagnosis or treatment

If telehealth is not suitable for your condition, you may need in-person evaluation or emergency care.

 

PATIENT RESPONSIBILITIES & CONSENT

By accepting this consent, you acknowledge:

• You understand the nature of telehealth services and their limitations.

• You will provide accurate and complete health information to your provider.

• You may withdraw your consent at any time, but Optimal T Clinic does not provide in-person visits.

• You understand that telehealth may not be appropriate for all medical concerns.

 

PRIVACY & DATA SECURITY

Our telehealth systems use encryption and security protocols to protect your privacy. However, electronic communications may have risks, including potential unauthorized access. We do not share your personal health information without your consent, except as required by law.

 

LABORATORY TESTING

Some healthcare services may require at-home lab tests provided by third-party laboratories. Optimal T Clinic cannot guarantee the accuracy of these tests. Inaccurate or inconclusive results may affect your diagnosis and treatment.

 

OPEN PAYMENTS NOTICE

The Physician Payments Sunshine Act requires disclosure of financial relationships between healthcare providers and medical product manufacturers. You can access this information at: Open Payments Database.

 

AGREEMENT & ACCEPTANCE

By clicking “I AGREE,” you confirm that you:
✅ Have read and understand this consent form
✅ Understand the benefits, risks, and limitations of telehealth
✅ Agree to receive care through telehealth at Optimal T Clinic

 

If you have questions, please contact us at office@optimaltclinic.com.

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Thank You!