Informed Consent
DrStellaMD's Telehealth treatment and payment policies and includes:
1. Your consent to receive medical treatment from contracted professional health care providers;
2. Your agreement to receive services using telehealth technology; and Your agreement to pay in full any charges that are your responsibility.
3. Your agreement to use the prescribed medications ONLY in the event of an emergency and under the guidance of a qualified healthcare professional.
By clicking “I agree to Terms of Use” on the DrStellaMD telehealth portal or health questionnaire, I understand and agree that I am signing this Consent electronically and that (i) I have reviewed, understand and accept the risks and benefits of telehealth services as described below and wish to receive such services, and (ii) I agree to the remaining terms of this Consent, including the terms of the DrStellaMD Privacy Notice described below.
Potential risks of telehealth include: (i) limited or no availability of diagnostic laboratory, x-ray, EKG, and other testing, and some prescriptions, to assist my medical provider in diagnosis and treatment; (ii) my provider’s inability to conduct a hands-on physical examination of me and my condition; and (iii) delays in evaluation and treatment due to technical difficulties or interruptions, distortion of diagnostic images or specimens resulting from electronic transmission issues, unauthorized access to my information, or loss of information due to technical failures.
I will not hold DrStellaMD's Medical or its contracted health care providers responsible for lost information due to technological failures.
I consent to the use of potential non-secure forms of communication that may contain sensitive health data.
I further understand that my Provider's advice, recommendations, and or decisions may be based on factors not within his/her control, including incomplete or inaccurate data provided by me.
I understand that my provider relies on information provided by me before and during our telehealth encounter and that I must provide information about my medical history, condition(s), and current or previous medical care that is complete and accurate to the best of my ability.
I may discuss these risks and benefits with the provider and will be given an opportunity to ask questions about telehealth services.
I understand that the level of care provided by my DrStellaMD Medical contracted provider is to be the same level of care that is available to me through an in-person medical visit. However, if my provider believes I would be better served by face-to-face services or another form of care, I will be referred to the nearest medical center, hospital emergency department or other appropriate health care provider.
In case of an emergency, I will dial 911 or go directly to the nearest hospital emergency room.
Liability Waiver
I hereby release and agree to hold harmless the Physician and all Physician assistants and staff from any liability, injury, damages, loss, accidents, delay or irregularity related to or arising out of my storage or use of the antibiotics and other medicines prescribed or issued pursuant to my telehealth encounter with Physician and any subsequent prescriptions and treatment.
Payment Policy
I acknowledge, understand and agree that:
1. I will pay at the time of service.
2. By providing my credit card information and receiving telehealth services, I (i) authorize DrStellaMD to charge my credit card for any and all unpaid amounts that DrStellaMD medical team determines are my responsibility, and (ii) agree to pay all amounts charged pursuant to this consent and authorization in accordance with the issuing bank cardholder agreement.
I understand that I may access and print a copy of these Terms and Conditions including Informed Consent to Telehealth