The quality of transmitted data may affect the quality of services.The inability to have direct, physical contact with the patient may impact the quality of service.While the likelihood may be low, these risks may include, without limitation, the following: Potential Risks: As with any medical procedure, there are potential risks associated with the use of telemedicine.Potential Benefits: The potential benefits of this service may include, without guarantee, improved access to medical care by enabling a patient to remain in his/her location.If you are not covered by insurance, you will be responsible for the billed charges for the telemedicine service. Cost: You will be responsible for any copayment, coinsurance, deductible or other out of pocket cost as determined by your insurance carrier and such may be charged by the practice before or after the telemedicine visit.Output data from medical devices and sound and video files.

The information you may be asked to provide may include any of the following:

Our providers may use the information you provide for purposes of diagnosis, recommending therapy or treatment follow-up and/or education.Electronic systems used will include measures to safeguard your information. Telemedicine involves the use of electronic communications.By utilizing the Practice’s telemedicine services you agree: You have the right, as a patient, to be informed about your condition and the recommended surgical, medical, or diagnostic procedure to be used so that you may decide whether to undergo the procedure after knowing the risks and hazards involved. If this is an emergency please contact emergency services by calling 911 immediately. You have scheduled your telemedicine appointment in advance with the Practice.You are a current patient of the Practice and are 18 years or older.By utilizing this telemedicine service, you acknowledge and agree to the following:

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