Telehealth Consent

I, (the “Patient”), hereby consent to engage in Telehealth services provided by (Preovum, LLC). I understand and acknowledge that Telehealth involves the use of electronic communications to enable healthcare providers to remotely evaluate, diagnose, and treat patients. By signing this consent form, I agree to the following:

1. Nature of Telehealth Services:

   1. I understand that Telehealth services may include, but are not limited to, video consultations, remote monitoring, and the use of electronic health records. These services are intended to provide me with access to healthcare professionals for the purpose of evaluation, consultation, diagnosis, and treatment.

2. Benefits and Limitations:

   1. I acknowledge that Telehealth services can offer certain benefits, such as increased access to healthcare, reduced travel time, and improved convenience. However, I understand that there are limitations to Telehealth, including but not limited to:
      a. Potential interruptions, technical difficulties, or limitations in technology that may affect the quality or availability of services.

   2. b. The inability of the healthcare provider to conduct a physical examination, which may limit the accuracy of diagnosis and treatment.

   3. c. The potential for electronic communication breaches, despite the Company’s efforts to maintain the privacy and security of my personal health information.

   4. d. The need for alternative or in-person care if the Telehealth services are deemed insufficient for my condition.

3. Confidentiality and Security:

   1. I understand that the Company will make reasonable efforts to maintain the privacy and security of my personal health information. However, I acknowledge that there are risks associated with electronic communication, including the potential for unauthorized access, hacking, or breaches. The Company will adhere to all applicable laws and regulations to safeguard my personal health information.

4. Emergency Situations:

   1. I understand that Telehealth services may not be appropriate for emergency situations or life-threatening conditions. In such cases, I should contact emergency services immediately or proceed to the nearest emergency department.

5. Fees and Insurance:

   1. I acknowledge that Telehealth services may be subject to fees, which will be communicated to me prior to the provision of services. I understand that insurance coverage for Telehealth services may vary, and it is my responsibility to contact my insurance provider to verify coverage and reimbursement policies.

6. Termination of Services:

   1. Either party may terminate Telehealth services at any time for any reason. The Company may terminate services if it determines that Telehealth is not appropriate for my condition or if there are technical or other difficulties that impede the delivery of quality care.

7. Consent and Release:

   1. I hereby consent to engage in Telehealth services with the Company and release the Company, its healthcare providers, employees, and agents from any claims, damages, or liabilities arising from the provision of Telehealth services, except those resulting from the Company’s gross negligence or willful misconduct.

8. I have read and understood the information provided above regarding Telehealth services. I have had an opportunity to ask questions, which have been answered to my satisfaction. By signing below, I voluntarily consent to participate in Telehealth services provided by Preovum, LLC.

Telehealth Services: Convenient Online Care by Preovum LLC