Terms and Conditions

These Terms and Conditions (“Terms and Conditions”) form a legal agreement between TeleMed2U Inc. and you, the individual (“you” and “your”) concerning your access to and use of the various services offered through the Website and any other website or online service that TeleMed2U Inc. operates (as defined below). Use of any of the Websites or Platforms constitutes your acceptance of these Terms and Conditions and the Privacy Policy.

TeleMed2U Inc., on its own behalf and on behalf of its affiliates and/or wholly-owned subsidiaries including but not limited to TeleMed2U, Inland Endocrine, Specialty Clinic of Austin, Medzino, BioBehavioral Research Austin, (collectively referred to as “TeleMed2U Inc.”, “we,” “us,” or “our”), TeleMed2U Inc. makes certain telehealth related information available to you and/or facilitates your access to telemedicine and expert medical services (“TeleMed2U Inc. Services”). TeleMed2U Inc. owns and operates (i) various publicly available websites, including without limitation, www.telemed2u.com, www.specialtyaustin.com, www.bbraustin.com, www.inlandendocrine.com, and www.medzino.com/us/ (collectively, “Websites”) and (ii) various web-based and mobile applications that require you to create an account in order to use a TeleMed2U Inc. Service (collectively, “Platforms”).

By using the Websites and/or the Platforms, you agree to these Terms and Conditions. If you do not agree to these Terms and Conditions, you should immediately suspend all use of and access to all of the Websites and Platforms. At any time, we may change these Terms or modify any features of the Services.  The most current version of the Terms can be viewed by clicking on the “Terms and Conditions” link.

Use of Our Websites/Platforms

TeleMed2U Inc. Services are not for emergency medical needs.  If you have a medical emergency, call 9-1-1 immediately.

TeleMed2U Inc. grants you a limited, non-exclusive, non-sublicensable, revocable, non-transferable license to use the Platforms through remote connectivity in accordance with these Terms and Conditions. In order to use the Platforms, you will be asked to register an account and create login information, including without limitation, username and passwords. You must protect your login information that you use to access the Platforms and you must not disclose this information to anyone. You must immediately notify TeleMed2U Inc. of any unauthorized use of your user account or of any other breach of security that you become aware of involving and relating to the Platforms by sending an email to privacy@TeleMed2U.com

Termination

Your access and use of the Websites and/or Platforms will be terminated if you violate these Terms and Conditions.  TeleMed2U Inc. may, in its sole discretion, terminate your access to the Websites and/or Platforms, or any portion thereof, for any reason without prior notice. 

TeleMed2U Inc.’s Role 

TeleMed2U Inc. is not an insurance provider. TeleMed2U Inc.’s role is limited to making information available to you and/or improving your access to telemedicine and medical services. TeleMed2U Inc. is independent from healthcare providers who will be providing such telemedicine services to you through the Platform and is not responsible for such healthcare providers’ acts, omissions or for any content of the communications made by them. All of the Providers are independent of TeleMed2U Inc, and Providers use the Services to communicate with you.  Any information or advice received from a Provider comes from the Provider, and not from TeleMed2U Inc.  TeleMed2U Inc. does not engage in the practice of medicine or provide any other health services.

Warranty

Access to the Website and the information contained therein is provided “as is” and “as available” without any warranty of any kind, express or implied. TeleMed2U Inc. does not warrant the accuracy, completeness or timeliness of the materials on this website and to the fullest extent permissible pursuant to applicable law.  TeleMed2U Inc. disclaims all warranties of any kind, either express or implied, including but not limited to any implied warranties of title, merchantability, fitness for a particular purpose or non-infringement, with respect to any information acquired through the website. TeleMed2U Inc. does not warrant that access to the website will be uninterrupted or error-free, or that defects, if any, will be corrected; nor does TeleMed2U Inc. make any representations about the accuracy, reliability, currency, quality, completeness, usefulness, performance, security, legality or suitability of the website or any of the information contained therein. You expressly agree that your use of the website and your reliance upon any of its contents is at your sole risk.

Your Representations 

By registering on the Platforms, you represent and warrant the following: (i) you are at least eighteen (18) years of age, (ii) you have the legal ability and authority to enter into these Terms and Conditions with TeleMed2U Inc., (iii) the information you have provided to TeleMed2U Inc. in your registration is accurate and complete, (iv) you will comply with any and all laws applicable to your use of the Websites and Platforms, (v) you will not interfere with a third party’s use of the Websites and Platforms, (vi) you will not interfere with or disrupt TeleMed2U Inc.’s or its vendors’ security measures, (vii) if any information you provide to TeleMed2U Inc. becomes inaccurate, incomplete or otherwise false or misleading, you will immediately notify TeleMed2U Inc., (viii) you are accessing the Websites and Platforms for yourself or a minor under the age of eighteen (18) years of age for whom you are the legal guardian.  You hereby certify that you are physically located in the State you have entered as your current location on the Services.

Prohibited Uses

In using the Websites and Platforms, you agree not to use, or attempt to access or use, the Services to take any action that could harm us or any third party, interfere with the operation of the Websites and Platforms, in a manner that violates any laws.  For example, and without limitation, you may not:

  • Send or otherwise transmit to or through the Websites and Platforms any unlawful, infringing, harmful, harassing, defamatory, threatening, hateful or otherwise objectionable material of any kind, any material that  can cause harm or delay to the Websites and Platforms or computers of any kind, and any unsolicited advertising, solicitation or promotional materials;
  • Misrepresent your identity or association in any way;
  • Restrict or inhibit any person from using the Websites and Platforms, disclose personal information obtained from the Websites and Platforms or collect information about users of the Websites and Platforms;
  • Reverse engineer, disassemble or decompile any section or technology on the Websites and Platforms, or attempt to do any of the foregoing;
  • Gain unauthorized access to the Websites and Platforms, to other users’ accounts, names, personally identifiable information or other information, or to other computers or websites connected or linked to the Websites and Platforms;
  • Launch or use any automated system, including without limitation, “robots,” “spiders,” or “offline readers,” that access the Websites and Platforms in a manner that sends more request messages to our servers in a given period of time than a human can reasonably produce in the same period by using a conventional web browser;
  • Send or otherwise transmit to or through the Websites and Platforms chain letters, unsolicited messages, so-called “spamming” or “phishing” messages, or messages marketing or advertising goods and services;
  • Post, transmit or otherwise make available any virus, worm, spyware or any other computer code, file or program that may or is intended to damage or hijack the operation of any hardware, software or telecommunications equipment;
  • Violate any applicable laws or regulations in any way;
  • Alter or modify any part of the content or services offered on or through the Websites and Platforms;
  • Allow any other person to use the Platforms with your registration or login information;
  • Breach or otherwise bypass TeleMed2U Inc.’s security or authentication measures; and
  • Assist or grant any person(s) in engaging in any of the activities described above.


Intellectual Property Rights and Content

TeleMed2U Inc. is the sole and exclusive owner of the Websites and Platforms, including any and all copyright, patent, trademark, trade secret and other ownership and intellectual property rights, in and to the Websites and Platforms and any related materials and documentation. No title or ownership of the Websites and Platforms or any portion thereof is transferred to you hereunder. TeleMed2U Inc. reserves all rights not expressly granted hereunder. You agree not to change or delete any copyright or proprietary notice related to materials downloaded from the Websites and/or Platforms.

You may provide input, comments or suggestions regarding the Websites and Platforms or TeleMed2U Inc. Services (“Feedback”). You acknowledge and agree that TeleMed2U Inc. may use any Feedback without any obligation to you and you hereby grant TeleMed2U Inc. a perpetual, irrevocable, royalty-free, transferable license not restricted to any geographical location to reproduce, display, perform, distribute, publish, modify, edit or otherwise use such Feedback as TeleMed2U Inc. may deem appropriate, without restriction, for any and all commercial and/or non-commercial purposes, in its sole discretion.

Indemnification

You agree to indemnify, defend and hold us and our parents, subsidiaries, affiliates, licensors, suppliers, and their directors, officers, affiliates, subcontractors, employees,  agents (each a TeleMed2U Inc. Party) and assigns harmless from and against any claims, actions or demands, losses, liabilities, damages, costs, expenses and settlements (including without limitation reasonable attorney and accounting fees), resulting from or alleged to result from, directly or indirectly, your (a) violation of these Terms and Conditions; (b) access to or use of the Platform and Websites; and (c) provision of other disclosure to TeleMed2U Inc. of any other information or data and the use of same by TeleMed2U Inc. or other TeleMed2U Inc. Party as contemplated hereunder.

Limitation of Liability

IN NO EVENT SHALL TeleMed2U Inc. BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, PUNITIVE, INCIDENTAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES, OR ANY DAMAGES WHATSOEVER RESULTING FROM ANY LOSS OF USE, LOSS OF PROFITS, LITIGATION, OR ANY OTHER PECUNIARY LOSS, WHETHER BASED ON BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE), PRODUCT LIABILITY, OR OTHERWISE, ARISING OUT OF OR IN ANY WAY CONNECTED WITH THE WEBSITES OR PLATFORMS OR THE PROVISION OF OR FAILURE TO MAKE AVAILABLE ANY SUCH PRODUCTS, GOODS, OR SERVICES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

TeleMed2U Inc. shall not be liable for any failure to perform its obligations hereunder where the failure results from any cause beyond TeleMed2U Inc.’s reasonable control, including, without limitation, mechanical, electronic, or communications failure or degradation.

The terms of these Terms and Conditions that limit liability express an informed voluntary allocation of risk; such allocation represents a material part of these Terms and Conditions. You agree that the limitations of liabilities set out in these Terms and Conditions are fair and reasonable in the circumstances.  Because some jurisdictions do not allow the exclusion or limitation of incidental or consequential damages, TeleMed2U’s liability in such jurisdictions shall be limited to the maximum extent permitted by law.  

Disclaimer of Warranties

The Websites and Platforms are provided on an “as is” and “as available” basis and without warranties of any kind, either express or implied. To the fullest extent permissible pursuant to applicable law, TeleMed2U Inc. disclaims all representations, warranties, and conditions, express or implied, including, but not limited to, implied condition or warranties of merchantability and fitness for a particular purpose. TeleMed2U Inc. does not warrant that the Websites and Platforms will be uninterrupted or error-free, that defects will be corrected or that the Websites and Platforms or the server that makes it available are free of viruses or other harmful components.

TeleMed2U Inc. makes no guarantees, and disclaims any implied warranty or representation about its accuracy, relevance, timeliness, completeness, or appropriateness of any content posted on the Website and Platforms for a particular purpose.  TeleMed2U Inc. assumes no liability arising from or relating to the delay, failure, interruption, omission or corruption of any data or other information transmitted in connection with use of the Websites and/or Platforms.

Applicable law may not allow the exclusion of implied warranties, so the above exclusion may not apply to you.

Direct to Consumer – Psychiatry Services

If you miss an appointment, we can work with you to get you rescheduled for another available slot. However, if you miss more than two consecutive appointments, we will have to cancel your subscription without a refund as this goes directly to the providers for the time that was set apart for you.

South Carolina Counselors Telehealth Registration Information

If you would like to verify a South Carolina Behavioral Telehealth provider, check the South Carolina Board Website license verification is located here: https://verify.llronline.com/LicLookup/Counselors/Counselors.aspx?div=18

Minors

The Websites and Platforms are not intended for use by anyone under the age of 18. If you are under 18 years of age, please do not use or access the Websites or Platforms at any time or in any manner. By using the Websites or Platforms, you affirm that you are over the age of 18. TeleMed2U Inc. does not seek through the Websites or Platforms to gather personal information from or about persons under the age of 18 without the consent of a parent or guardian. TeleMed2U considers anyone below the age of 18 as a “minor” and delivers various services to minors. A patient account for minors must be created and managed by a parent, a legal guardian, or an authorized representative. 

Choice of Law and Jurisdiction

These Terms and Conditions are governed by the laws of California. The parties irrevocably submit to the exclusive jurisdiction of the courts of the State of California in respect of all matters and disputes arising hereunder, and waive any defense of lack of personal jurisdiction in that jurisdiction. These Terms and Conditions are not governed by the United Nations Convention on Contracts for the International Sale of Goods, the application of which is hereby expressly excluded. If any provision of these Terms and Conditions is found to be invalid by any court having competent jurisdiction, the invalidity of such provision shall not affect the validity of the remaining provisions of these Terms and Conditions, which shall remain in full force and effect.

Personal Information and Privacy Policy

In these Terms and Conditions, “personal information” means any information about an identifiable individual, such as your name, email address, mailing address, gender, date of birth, any personal or protected health information, or, any data about you that you elect to provide electronically through the Websites and Platforms and any other information that identifies who you are. Personal Information will be used by TeleMed2U Inc. solely in accordance with these Terms and Conditions, and TeleMed2U Inc.’s Privacy Policy.

Waiver

No delay or omission by TeleMed2U Inc. to exercise any right or power it has under these Terms and Conditions or to object to the failure of any covenant of you to be performed in a timely and complete manner, shall compromise any such right or power or be construed as a waiver of any ensuing breach or any other covenant. Any waivers by TeleMed2U Inc. must be in writing and signed by an authorized representative of TeleMed2U Inc..

Contact Us

If you have any questions about the Terms and Conditions or need to provide notice to, or communicate with, TeleMed2U Inc. under the Terms and Conditions, please contact TeleMed2U Inc. using the following contact details:

3400 Douglas Blvd.
Suite 225
Roseville, CA 95661
Phone: (855) 446-8628

privacy@TeleMed2U.com

TeleMed2U Inc. may provide notices or communications to you on the Websites and/or Platforms and you agree that such notices shall constitute notice to you whether or not you actually access the notice.

OFFICE POLICY AND PROCEDURES

PATIENT RESPONSIBILITIES

For in person appointments at a facility, plan to arrive 10 minutes prior to your scheduled appointment time to allow adequate time to complete the check-in and payment process. Your appointment will end at its scheduled time regardless of any time lost at check-in or due to late arrivals.

Payment of copayments, coinsurance, deductibles, or self-pay rates is due in full at the time of service. Some services may not be covered under my insurance plan, and I am financially responsible for any non-covered services. We will have no choice but to reschedule your appointment if you are unable to pay for your visit at the time of service (except in the rare case of psychiatric emergencies). You are solely responsible for the payment of your account regardless of payment or lack of payment by any insurance carrier or other guarantor. Account balances will not be allowed to accrue. You will not be eligible to check-in for your appointment until outstanding balances are paid in full or a payment plan has been established.

Claim forms will be submitted for insurance carriers with which we are in the network. I authorize payment of medical benefits to be made to my clinician. In the event my insurance carrier does not pay my claim within a reasonable amount of time, I may be billed for services provided.  For carriers we are not contracted with, you may ask us to mail you a receipt which includes the information necessary for you to file the claim. Your insurance carrier will provide us with an estimate of your copayment or coinsurance rates prior to your appointment. Any questions or complaints regarding coverage should be directed to your carrier.

It is your responsibility to notify our billing office if your insurance coverage changes in advance of your appointment, or arrive 20 minutes prior to your appointment to speak with a billing representative in person. Your appointment may be rescheduled if the insurance verification process delays your appointment start time. 

Text message, e-mail, and telephone reminders are a courtesy service only.You are responsible for your appointment whether or not your reminder was received. Appointments must be canceled or rescheduled at least 24 hours in advance.  You will be discharged from the practice if you provide late cancellation or fail to show up for two consecutive appointments at any time during the course of treatment.

You may be discharged from the practice if you fail to follow up for greater than 6 months after your last office visit, or 4 months after your recommended follow-up time frame. Follow-up appointments ensure the safety of patients who are continuing on medication maintenance therapy. The frequency of these appointments depends on your clinical condition and the medications utilized. Patients with greater than 60 days beyond the recommended follow-up time frame will be scheduled for an appointment of extended duration to allow time for re-assessment. 

If you arrive late to your appointment, the time for your session will be reduced accordingly; you will only be seen for the remainder of the time left in your reserved appointment slot.  Patients arriving 10 or more minutes late to their scheduled appointment time will be offered the option to wait for another appointment time on the same day (if one is available) or to reschedule the appointment.

Prior authorizations are a courtesy service. While we make every effort to secure coverage of prescribed medications, it is ultimately your responsibility to contact your insurance company to determine which medications are covered or to request appeals for coverage decisions.

Medications will only be refilled for current patients who maintain their regularly scheduled appointments.  If you are overdue for follow-up and in need of a refill please call to schedule an appointment; at that time, your clinician may authorize a temporary refill. 

Refills may be requested by calling the pharmacy to request refill or by sending our office a message.  Refills must be requested at least 3 business days prior to running out of medication. Changes in any controlled substance prescription will only be made in the context of a visit and never during non-clinic hours.  Refills are exclusively provided as determined by my clinician, will only be granted if I keep my scheduled appointments, and will not be granted outside of regular business hours.

You are responsible for complying with your prescribed medication regimen.You should not make any changes to your medication regimen without first consulting your clinician. It is your responsibility to inform your clinician of all other medications you are taking, including over-the-counter medications and supplements.

All correspondence will be transcribed by staff as part of your medical record. If it becomes necessary to address your concern directly with your provider please be aware that these calls are limited to 5 minutes. Any calls greater than 5 minutes are subject to fees ($25 for each 5 minute increment following the first 5 minutes). This includes telephone consultations with family members including guardians of minors.

Email is not a secure form of communication and using it may risk the security of your protected health information. Email communication should never be used to communicate confidential information or urgent or emergency issues.

In the event of an urgent psychiatric matter outside of regular clinic hours you may contact the on-call clinician by calling the office and following the appropriate prompts on our telephone greeting. This service should be utilized only for urgent matters that cannot wait until the next business day (i.e., suicidal thoughts or thoughts of harming others, serious medication reactions, or unusual behavior that may lead to physical harm). Nonurgent issues (i.e., medication refills, scheduling, or billing issues) may be addressed by sending a message or by leaving a voicemail message for the clinic staff.  Calls placed for non-emergency issues will result in being charged a $25 fee for after-hours care. If the matter is not urgent or emergent you may not receive a return call from the on-call provider.  In the event of a life-threatening emergency please call 911 or go to the nearest Emergency Department. Do not delay care by waiting for a response from our on-call provider.

It is often unforeseen but legal matters requiring the testimony of a mental health professional can and do arise. Legal testimony can often be damaging to the relationship between a patient and his or her clinician. As such, we require that you employ independent forensic psychiatric services should this type of evaluation or testimony be required. If any of our clinicians are deposed or subpoenaed on your behalf and required to testify or appear in court, you will be responsible for our court fees which are $4500 per day and will not be prorated (because attending court necessitates blocking the clinician’s schedule for the entire day).This fee must be paid upfront and in full. We will not complete custody evaluations or parental assessments for use in determining custody or visitation, CPS evaluations, or disability evaluations. You must find a forensic professional to assist you in these purposes.

Additional documentation is needed regarding treatment of minors of divorced parents. Minors 17 years of age or younger must be accompanied by a parent or legal guardian. Under no circumstances will medication changes be authorized without a parent or legal guardian present.

At times, termination of care between a patient and provider is necessary.Termination of treatment may occur at any time and may be initiated by either the patient or the provider.  We will assume that you have terminated care if you fail to show up for a scheduled appointment and do not contact our office within 60 days of this missed appointment, or you do not schedule and attend a follow up appointment within 6 months of your last scheduled appointment. 

CANCELLATION AND NO-SHOW POLICY:

At Specialty Clinic of Austin, we understand that sometimes unexpected events happen that may prevent you from keeping your scheduled appointment. However, in order to provide the best possible care for all of our patients, we have implemented the following Cancellation and No-Show Policy:

CANCELLATION POLICY:

We kindly request that you provide us with at least 24 hours notice before your scheduled appointment time if you need to cancel or reschedule your appointment. This will allow us to offer the appointment time to another patient who may be in need of medical care. If you fail to provide us with at least 24 hours notice, a $50 cancellation fee will be charged to your card on file, if there is no card on file the balance will be applied to your account until settled.

NO-SHOW POLICY:

If you miss your scheduled appointment without prior notice or explanation, it is considered a “no-show”. A $50 no-show fee will be charged to your card on file, if there is no card on file the balance will be applied to your account until settled.
We understand that unexpected events can happen, and we will take into account extenuating circumstances on a case-by-case basis. However, we ask that you please do your best to give us as much notice as possible if you need to cancel or reschedule your appointment so that we can provide timely care to all of our patients.
Thank you for your understanding and cooperation in helping us provide the best possible care for our patients. If you have any questions about our Cancellation and No-Show Policy, please do not hesitate to contact us.

CONTROLLED SUBSTANCE PRESCRIPTIONS

Controlled substance prescriptions (i.e., benzodiazepines, stimulants, hypnotic sleep aids) have a high potential for misuse and are closely regulated by local, state, and federal governments. Our clinicians must observe strict rules in order to minimize the risks of abuse and misuse. All patients with TeleMed2U Inc. must agree to follow the policies outlined in this agreement as a condition of the provision of controlled substance prescriptions by my clinician.

Your signature acknowledges understanding of the following statements:

Consumption of controlled substances is associated with risks including, but not limited to, psychological addiction, physical dependence, withdrawal, and overdose.

Temporary refills will not be granted for controlled substances. 

Utilization of the prescribed medication will be as instructed. Changing the way I take my medication is prohibited and can result in adverse health outcomes.

  • I will not alter the date, quantity, and/or strength of my prescribed medications. 
  • I will not break, chew, crush, inject, or snort my medications.  
  • I will not alter a prescription by any means, shape, or form. Forging prescriptions and/or my clinician’s signature violates state and federal law. 
  • I agree to keep my prescription(s) in a secure and safe location and to safeguard my prescription(s) against loss or theft. 
  • I will not sell my medication or share it with others, or in any other manner enable other individuals to possess or use my prescribed medications.

No premature refills will be granted regardless of the circumstances. I must wait until the next eligible fill date to receive another prescription.  I may be discharged from the clinic if I request an early refill secondary to lost, damaged, or stolen prescriptions twice within one year.

My clinician follows state and federal recommendations regarding the use of urine toxicology screens to monitor controlled substances use. I agree to the following requirements for urine toxicology screenings, which will be ordered by my clinician prior to prescribing a controlled substance and randomly during the course of my treatment:

  • Any charges associated with the toxicology screen will be my responsibility if they are not covered by my insurance carrier.  
  • Refusal to consent to toxicology screens, the presence of non-prescribed or illicit substances in my sample, or the absence of prescribed medications in my sample will result in discontinuation of controlled substances and may result in termination of care. 
  • In the event of inconsistent results, my clinician may contact me to present to the office for a follow-up test; if I fail to present within 24 hours of receiving this request, my controlled substance prescriptions will be terminated. I must keep my contact information current so my clinician may reach me, as any missed tests will be considered to be a violation of this agreement.

All medications for the treatment of my psychiatric condition will be obtained solely from TeleMed2U Inc. unless previous clearance has been obtained by my TeleMed2U Inc. clinician. I will not obtain controlled substance prescriptions from multiple providers. If I receive other controlled substance prescriptions from any source other than my TeleMed2U Inc. clinician, without notifying my TeleMed2U Inc. clinician, I will be discharged from the clinic.  

I understand and consent that my clinician can and will utilize the following resources to obtain a history of my prescribed medications: 

  • Requesting information from my past/current treating physician,
  • Requesting information from my current or previous pharmacy, and
  • Prescription Drug Monitoring Database (PDMP) reports.  My reports will become part of my medical record. 

I will communicate with other providers who are treating me that I am under a controlled substance agreement with TeleMed2U Inc. I consent to release this agreement information to other providers, emergency departments, pharmacies, and consultants to allow pharmacies to release my prescription history. I also consent for other providers, emergency departments, pharmacies, and consultants to report violations of this agreement to TeleMed2U Inc. and my primary care provider.

My clinician will be informed of any new medications or medical conditions that arise during the course of my treatment. I will notify my clinician of any adverse effects I experience from any of the medications I consume.

My clinician will be informed of any current or past substance abuse. I am aware that attempting to obtain a controlled substance under false pretenses is illegal.  I agree not to use alcohol or any illegal substances (including, but not limited to, marijuana, heroin, cocaine, and amphetamines) while under this agreement.  I understand that driving while under the influence of any substance, including a prescribed controlled substance, or any combination of substances which impairs my driving ability, may result in DUI charges and/or other legal charges.

Violation of any of the above policies, all orders for my controlled substance prescriptions will cease, and I will be dismissed. I understand that my clinician fully cooperates with local, state, and federal law enforcement agencies as well as the Drug Enforcement Agency (DEA) and the Department of Public Safety (DPS) in regards to infractions involving prescription medications. My pharmacy, local authorities, and the DEA will be notified if my treating clinician believes that I have violated the laws regarding controlled substance prescriptions in any manner.  If the responsible legal authorities have questions concerning my treatment, all confidentiality is waived, and these authorities may be given full access to my full records of controlled substance administration.

CONSENT TO TREATMENT

As the patient or their legal representative, I hereby request and consent to psychiatric services for myself/dependent which includes routine/crisis screening, examination, diagnostic assessment, laboratory screenings and procedures, and other treatments/services (e.g. psychotherapy, medication management, referral for psychological testing) recommended by my clinician, his/her assistants, or designee as is necessary in his/her judgment. I understand that I have the option to accept or reject any recommendations for services. 

I authorize my clinician and TeleMed2U Inc. to use and disclose my personal health information to receive payment for the care I receive. I have received a copy of the Notice of Privacy Practices (NOPP) with further details on how my health information may be used, and I have been provided an opportunity to review it. I have also been informed that identifying information about me may be exchanged between the clinicians at TeleMed2U Inc. or its affiliates for coverage purposes or continuity of care purposes. 

I have been advised that I am financially responsible for any services provided by any provider at TeleMed2U Inc. or its affiliates. 

TELEMEDICINE CONSENT

Telemedicine involves the real-time evaluation, diagnosis, consultation on, and treatment of a health condition using advanced telecommunications technology, which may include the use of interactive audio, video, or other electronic media. As such, telemedicine allows the provider to see and communicate with the patient in real-time. 

I voluntarily request TeleMed2U Inc. provider(s) and such associates, technical assistants, and other health care providers as they may deem necessary (“TeleMed2U Inc. Telemedicine Providers”) to participate in my medical care through the use of telemedicine. 

I understand that TeleMed2U Inc. Telemedicine Providers (i) may practice in a different location than where I present for medical care, (ii) may not have the opportunity to perform an in-person physical examination, and (iii) rely on information provided by me. I acknowledge that TeleMed2U Inc. Telemedicine Providers’ advice, recommendations, and/or decisions may be based on factors not within their control, such as incomplete or inaccurate data provided by me or distortions of diagnostic images or specimens that may result from electronic transmissions. I acknowledge that it is my responsibility to provide information about my medical history, condition, and care that is complete and accurate to the best of my ability. I understand that the practice of medicine is not an exact science and that no guarantees are made to me as to result or cure. 

If TeleMed2U Inc. Telemedicine Providers determine that the telemedicine services do not adequately address my medical needs, they may require an in-person medical evaluation. In the event the telemedicine session is interrupted due to a technological problem or equipment failure, alternative means of communication may be implemented or an in-person medical evaluation may be necessary. If I experience an urgent matter, such as a bad reaction to any treatment after a telemedicine session, I should alert my treating physician and, in the case of emergencies, dial 911, or go to the nearest hospital emergency department. 

To facilitate the provision of care and/or treatment through telemedicine, I voluntarily request and authorize the disclosure of all and any part of my medical record (including oral information) to TeleMed2U Inc. Telemedicine Providers. I understand and agree that the information I am authorizing to be released may include: 1) AIDS/HIV test results, diagnosis, treatment, and related information: 2) drug screen results and information about drug and alcohol use and treatment; 3) mental health information, and 4) genetic information. 

I understand that the disclosure of my medical information to TeleMed2U Inc. Telemedicine Providers, including the audio and/or video, will be by electronic transmission. Although precautions are taken to protect the confidentiality of this information by preventing unauthorized review, I understand that the electronic transmission of data, video images, and audio is new and developing technology and that confidentiality may be compromised by failures of security safeguards or illegal and improper tampering. 

For Subscription Programs/ Cash-pay:

Insurance Coverage

Subscription services offered using this site may not be fully covered by health insurance, Medicare, or Medicaid.  Subscription services do not include the cost of any recommended prescriptions, follow-up lab work, or visits that must be referred to another healthcare entity if deemed applicable.  You may choose to cancel your subscription any time.

Coverage and benefits for services vary based on insurance company and location.  TeleMed2U offers competitive and affordable pricing options which are typically comparable with the cost of most insurance plans.  If you choose an option to pay for services without health insurance, Medicare, or Medicaid, we will not file a claim with your insurance company.  Speak with your health insurance company prior to the visit for any questions on filing for reimbursement or about covered services.  

Finally, thank you so much for visiting our website and using our services. We look forward to helping you.

The TeleMed2U Team