Telehealth Consent

Please read and confirm before your video or telephone appointment.

Full name (required)Date of birth (required)Email address (required)Phone number (required)Which country and region will you be in? (required)

How it works

A remote consultation has limits. Your clinician cannot examine you physically, and some conditions cannot be assessed safely without an in-person appointment, tests or imaging. If that turns out to be the case, we will tell you and arrange it - the consultation is not wasted, but it may not end with a diagnosis.

I understand the limitations of a remote consultation (required)

I understand I may still need to be seen in person (required)

I understand the connection may fail, and that we will continue by telephone if it does (required)

Privacy

Where will you take the call? (required)

I understand I should be somewhere private, and I'm responsible for my own surroundings (required)

May we record the consultation for your medical record? (required)

Someone else will be with me during the consultation

Emergencies

If you develop severe symptoms before or during the appointment, do not wait for the consultation - call the emergency services.

I understand this is not an emergency service (required)

I consent to a consultation by video or telephone (required)