TintedMD adheres to strict HIPAA security and privacy requirements. All medical records and personal health information are maintained within secure, HIPAA-compliant systems. Access to this information is strictly limited to you and the licensed healthcare professional involved in your evaluation. Your information is private, protected, and handled with the highest standards of confidentiality and security.

Agreement for Telehealth Services Consent

TintedMD Telehealth Services Consent

I acknowledge that TintedMD provides administrative and technology services that facilitate my connection with a licensed healthcare professional (“Provider”) through its online platform for medical evaluations related to light sensitivity and medical window tint exemptions. These services may include medical assessment, review of medical history, documentation, follow-up, and education.

Telehealth includes consultations, evaluations, the transfer of personal and health information, emails, telephone conversations, and education using interactive audio, video, and electronic data communications. Telehealth involves the use of electronic communications technologies. I hereby consent to engage in Telehealth services with my Provider.

I understand that my Provider is an independent contractor and is not an employee or agent of TintedMD. My Provider may require me to execute additional informed consent documentation prior to engaging in Telehealth services.

Benefits of Telehealth

I understand that the expected benefits of Telehealth may include:

• Improved access to licensed healthcare professionals

• The ability to complete medical evaluations remotely

• Efficient review and documentation of medical conditions

• Access to Providers licensed in the state in which I reside

Confidentiality

I understand that I have the same rights to confidentiality for Telehealth services as I would for in-person medical services. Any personal or health information disclosed during Telehealth encounters is confidential to the extent permitted by law.

Risks of Telehealth

As with any form of medical care, there are potential risks associated with Telehealth, including but not limited to:

(a) In rare cases, information transmitted may be insufficient for appropriate professional decision-making (e.g., poor video or image quality);
(b) Delays in evaluation or documentation due to equipment or technical failures;
(c) The possibility of disruption, distortion, or unauthorized access to personal information due to internet or electronic failures beyond the control of TintedMD or the Provider.

Acknowledgments and Consent

By agreeing to Telehealth services, I acknowledge and understand the following:

• Telehealth is the use of electronic communications to deliver healthcare services when the Provider and patient are in different locations.

• I may need certain technical or system requirements to participate in Telehealth services and am solely responsible for obtaining and maintaining them.

• I have the right to withhold or withdraw consent to Telehealth at any time without affecting my right to future care.

• Alternative methods of medical care may be available, and I may choose other options at any time.

• All information I provide to TintedMD and the Provider is accurate and truthful, and I will update it as necessary.

• There are legal exceptions to confidentiality, including but not limited to mandatory reporting of abuse, threats of harm, danger to self or others, legal proceedings, or as otherwise required by law.

• I am responsible for maintaining privacy in my physical environment during Telehealth sessions.

• If the Provider determines that Telehealth is insufficient to provide appropriate clinical information, I may be advised to seek an in-person evaluation.

• I will inform my Provider of any relevant electronic or in-person interactions I have with other healthcare providers.

• Telehealth services may not be equivalent to face-to-face care in all circumstances.

• Despite appropriate evaluation, outcomes cannot be guaranteed and my condition may not improve.

• I have had the opportunity to review the Provider’s credentials prior to the consultation.

• Technical failures may occur, and I agree to hold harmless TintedMD and my Provider for delays or data loss caused by such failures.

Emergency Situations

I understand that TintedMD does not provide emergency services. If I experience a medical emergency or crisis, I agree to call 911 or seek immediate emergency assistance. TintedMD cannot directly connect me to emergency or crisis services.

No Guarantee of Certification

I understand that TintedMD does not guarantee that a Provider will issue a medical window tint exemption or that any state authority, law enforcement agency, or third party will accept or honor documentation issued following a Telehealth evaluation.

Use and Sharing of Information

I understand that my healthcare information may be shared with authorized individuals for purposes including scheduling, administrative processing, billing, and compliance, in accordance with applicable laws and TintedMD’s Privacy Policy.

Consent and Authorization

I confirm that I have read and understand the information above, that all my questions have been answered, and that I voluntarily consent to receive Telehealth services. By clicking “I AGREE” and typing my name electronically, I authorize the Provider facilitated by TintedMD to conduct a medical evaluation via Telehealth.

I agree that an electronic copy of this consent shall be treated as a signed original.

This authorization shall remain valid until revoked by me in writing or as otherwise provided by law. A copy of this authorization shall be as valid as the original.