Condition

I understand that telemedicine or telehealth visits are reserved for mild to moderate conditions and may not be appropriate for severe or life-threatening illnesses.

I understand that medical evaluation, diagnosis and treatment offered on Partner are virtual or asynchronous in the absence of a face to face physical examination.

I agree to call 911 or seek emergency care if your symptoms or condition worsen or immediate medical is required after your telemedicine visit.

I agree to continue the recommended routine physical visit with an in-person physician while utilizing telemedicine as secondary means of accessing healthcare.

I certify that I do not have any cognitive impairment and capable of making sound medical decisions.

I understand that I'm engaging in telemedicine (telehealth) consultation and I accept the risk of misdiagnosis due to the absence of in-person evaluation or diagnostic tools.

I certify that I must be an adult patient or an adult legal guardian of a minor patient to use the Partner platform.

I understand that services rendered by Partner are provided on a non-refundable basis.

I understand that my payment to Partner , the consultation fee, may not cover the prescribed medication and I still have to pay for the prescribe medication at the pharmacy.

I understand that I must provide Partner with the most accurate and up to date information about my health, medical history, medications, allergy and diagnostic reports to avoid misdiagnosis.

I understand the health history, medical history, medication list, allergy list, diagnostic reports and any other information I provide to Partner and its representative will be used to evaluate and provide my assessment and treatment plan.

I understand that, by failure to obtain or provide requested diagnostic lab or images studies may increase the risk of misdiagnosis and treatment failure. I will not hold Partner and its representatives responsible for any misdiagnosis and treatment failure caused by failure to furnish or comply with medically necessary diagnostic studies.

I hereby acknowledge that I'll follow-up with a doctor in-person for a face to face to re-evaluation if my symptoms worsen or do not improve timely after this telehealth visit.

I understand that the consultation fee covers this only single visit, and acknowledge that a prescription refill request or re-evaluation visit on a different day may incur additional fees and charges.

I have been informed that telemedicine is a supplement to, not a replacement for, in-person physician visits.

I have been informed that electronic communication via email or other asynchronous electronic medical record transfer may delay the delivery of care via telemedicine. However, it's my responsibility to request a cancellation in order to seek immediate care elsewhere if this delay poses a health risk.

I understand that I can cancel the telemedicine visit prior to the consultation status being marked as completed. A complete status is non-refundable.

I understand that it's my responsibility to follow-up with a doctor or in-person for further evaluation, lab testing especially if my condition does not improve in a timely manner.

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