To better serve the needs of people in the community, health care services are now available by interactive video communications and/or by the electronic transmission of information. This may assist in the evaluation and management of a number of health care problems. This process is referred to as “telemedicine” or “telehealth.” This means that you may be evaluated and treated by a health care provider or specialist from a distant location. Since this may be different than the type of consultation with which you are familiar, it is important that you understand and agree to the following statements.
- The consulting health care provider or specialist will be at a different location from me.
- The presenting practitioner may transmit or share electronically details of my medical history, examinations, x-rays, tests, photographs or other images with another specialist who is at a different location.
- I will be informed if any additional personnel are to be present other than myself, individuals accompanying me, the presenting practitioner and, via video, the consultant. I will give my verbal permission prior to the entry of the additional personnel.
- The video chat consultations maybe recorded for other health care providers to review.
- RELEASE OF INFORMATION: I authorize to release information from my medical record to any other health care facility or provider to which my care may be transferred.
- I voluntarily consent to health care services provided by my doctor(s) or a designee, which may include health history review, nutritional evaluation, diagnostic tests and medications considered ideal for me to optimize my wellness goals.
- I understand that I may be released before all my medical problems are known or treated and it is my responsibility to make arrangements for follow-up care.
The information provided by Advanced Integrative Medical 360 is designed for and solely intended to enhance and optimize nutritional performance and overall general wellness. Use of any information provided is completely voluntary and each client is solely responsible for their voluntary choice to implement the dietary, supplement or medication recommendations. It is the sole responsibility of the client to provide complete and accurate information. Any misinformation or omitted information may affect the nutritional assessment or advice. Any misrepresented information is solely the client’s responsibility and Advanced Integrative Medical 360, will not be liable.
Advanced Integrative Medical 360 provides wellness virtual consultations and medication recommendations only and does not diagnose, treat, or cure medical conditions or diseases. The client must consult their personal physician for any diagnosis of any medical conditions. Advanced Integrative Medical 360 does not replace your medical physician.
I have volunteered to participate in a wellness program or wellness virtual visit under the direction of Advanced Integrative Medical 360 which will include, but may not be limited to nutritional advice, supplementation and/or medications. In consideration of Advanced Integrative Medical 360’s agreement to assist me, I do here and forever release and discharge and hereby hold harmless Advanced Integrative Medical 360 and their respective agents, heirs, assigns, contractors, and employees from any and all claims, demands, damages, rights of action or causes of action, present or future, arising out of or connected with my participation in any wellness program or virtual wellness visit including any injuries resulting there from.
Assumption of Risk
Advanced Integrative Medical 360 recommends you consult your physician before undertaking any diet or exercise program.
I recognize that specific dietary programs, supplements and new medications may create possible interactions with my existing medications or medical conditions. I understand the use of dietary supplements and dietary advice is voluntary and I assume all risks.