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Great Doctor USA Consent Form

  1. I hereby authorize Great Doctor USA to use the the information on these forms for telecommunication for evaluating, testing and diagnosing my medical condition.
  2. I understand that technical difficulties may occur before or during the form submission sessions and my appointment cannot be started or ended as intended.
  3. I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.
  4. I understand that my current insurance may not cover the additional fees of the telehealth practices and I may be responsible for any fee that my insurance company does not cover.
  5. I agree that my medical records on website can be kept for further evaluation, analysis and documentation, and in all of these, my information will be kept private.