Evercurrent Telemedicine Consent Form

Email: contact@evercurrentmed.com

Website: www.evercurrentmed.com

1. Purpose

This form is to obtain your consent to participate in a telemedicine consultation with Evercurrent.

2. What Is Telemedicine?

Telemedicine involves using secure electronic communications (such as video calls, telephone, or messaging) to provide clinical services without an in-person visit.

3. Benefits

• Access to care without travel
• Shorter wait times
• Access to specialists and follow-up care

4. Risks

• Technology or internet failures
• Limited ability to perform some physical exams
• Possible privacy breaches despite safeguards

5. Your Rights in Florida

You may refuse telemedicine at any time, request in-person services, and request access to your medical records.

6. Confidentiality

Evercurrent complies with HIPAA and Florida laws. Your information is protected through encrypted platforms.

7. Patient Responsibilities

• Provide accurate medical information
• Be in a private and safe space for your visit
• Understand that some conditions may require in-person care

8. Consent

By submitting this form, you consent to receive healthcare services via telemedicine and confirm that you understand the risks and benefits.