Consent To Telehealth
Last updated: February 1st, 2017
The purpose of this particular informative document is to obtain your consent to accept general medical services through telemedicine.
Kindly take into consideration that you can only use our medical telemedicine services after you go through and read this particular information below and afterward made a complete informed decision about using our services. Also note that by clicking Accept during the registration of your account, you give your whole permission to Dialdoc to medically care for you through telehealth.
Take into consideration if by any chance you want to withdraw this particular consent and no longer want to seek care from Dialdoc you can delete your account at any time.
This electronic acceptance notice is for patients that reside in the state of Arizona. In case of any questions, kindly contact us at [email protected] or by calling us at (520) 301-1603.
I completely understand that as a patient or user of Dialdoc telemedicine system visit, consult or appointment at any giving time without affecting my rights what so ever; I can cancel my participation to go through the system and seek help somewhere else.
I complete understand and accept that videos, pictures or recording may be a requirement for me to complete the procedure and the service through the telemedicine software use by Dialdoc.
I understand and accept that perhaps a physical examination will take place for me to continue with the medical service as a patient.
I complete understand and accept that a health care provider has discussed with me all the particular information above regarding telemedicine.
I am full aware and complete have the understanding that even though Dialdoc as medical organization uses the best of technology to guard and secure everything about my health information and have a full comply system with HIPPA. However, Dialdoc cannot guarantee the full privacy and discretion of my personal health information.
Kindly note if there is anything else you want to know about how we go above and beyond to protect your personal health information, or how we comply with all the HIPPA laws that demand the protection of your information, you can check more detail in our privacy policy.
I had the opportunity to ask any particular questions and get the answers about all the information above as well as any related topic involving my care through telemedicine consult, visit or appointment.
I complete understand and full aware that Dialdoc has the absolute right at any time to refuse in any way to take responsibility for my medical care. I am also aware, to the full extent that making any particular request for treatment by visiting the website and making payment or just getting in contact through email, does not in any way or form create a medical relationship or duty of care.
I complete understanding that there may be some sort of delay when it comes to get any response back from my medical team.
I am full aware and complete understand that any type of material know as content within this particular website content is not consider any kind of medical advice.
I am full aware that I will be at risk and have negative consequence to my health, if I provide personal and health information that is not true about my medical history or current health problems.
I understand and well aware that I cannot create more than one account, since the medical providers may be confuse at the time of checking my medical history and cannot rely on it to further assist me to better my health.
It’s my understanding that by using the medical services provided by Dialdoc, I’m giving my 100% full and explicit agreement for any medical provider that is consider a member of Dialdoc to see me as a patient through telemedicine and access my personal and medical history and information about me.
I understand that members of Dialdoc team, if it is complete appropriate, may take my full medical history as well as personal to determine any sort of treatment for my illness or reason for the telemedicine visit.