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I agree to the Terms and Conditions of Top Notch Vitality (with Terms and Conditions Highlighted) and once clicked on will display the information below in a popup box.
In submitting my health information (symptoms, conditions, comments, answers to questions, and fully-completed Health Information) in connection with my request for services, the following statements are true:
1. I am an adult of at least 18 years of age.
2. I am competent to use the services offered by Top Notch Vitality and I fully understand the material and information contained therein.
3. I voluntarily choose to seek a clinician consultation through telemedicine/online medicine
4. I recognize that the consulting clinician reviewing my Health Information may or may not prescribe treatment based on my responses.
5. I am aware that my failure to provide truthful, accurate and complete information to the consulting clinician and any other providers could result in an inappropriate treatment decision that could be harmful to me or not be safe and effective. Therefore, I have responded or will respond to each question truthfully and accurately, and I acknowledge that I fully and completely disclosed any and all information concerning my health and medical history that could be relevant to my current condition and need/desire for treatment and/or medication.
6. I agree to inform my personal physician about the products/medications/prescriptions ordered, administered, or supplied, as applicable, from Top Notch Vitality.
7. I will contact my primary care physician if I have questions, difficulties, or complications with recommended treatment(s). I will make my primary care physician aware of my visit and any medications administered and/or prescribed by Top Notch Vitality.
8. I understand that I will be given the opportunity to ask any and all questions about any tests, procedures, or medication(s) that may have been prescribed for me.
9. I understand that the consulting clinician is a licensed medical practitioner, and is not my personal primary care physician. I understand that the consulting clinician is compensated for reviewing my health information. The consulting clinician is compensated for this review and consultation only.
10. I understand that there are risks as well as benefits in having tests and/or procedures performed, and/or when taking any medication. I acknowledge that I will not hold Top Notch Vitality, the consulting clinician, or any entities, affiliates, employees, partners or agents associated with Top Notch Vitality responsible for any adverse effects/events caused by any medication(s)prescribed, procedures performed, tests ordered, or insufficient/inaccurate diagnosis and treatment procedures/plans of care ordered by the consulting clinician at Top Notch Vitality, due to the nature of the lack of an in person physical examination, and the reliability of the truthfulness and accuracy of the information I am providing.
11. If paying by credit, debit card, FSA, HSA, or CareCredit Card, I acknowledge that I am the owner of said card, or I am permitted by law to use said card.