Telehealth Intake Form

Terms and Agreement

Please read the following carefully before proceeding:

• I acknowledge that this clinic operates virtually and requires access to a telemedicine platform.
• I understand that all medical consultations and prescriptions are supervised by a licensed MD.
• I confirm that I am 18 years or older.
• I agree to provide accurate and truthful information to facilitate a personalized consultation.
• I understand that the consultation fee is non-refundable unless the clinic cancels the appointment.

By clicking submit, I confirm that I have read and agreed to the terms outlined above.