Release of Health Information
“Patient” is defined as myself, a family member, or a legal guardian of a minor.
By accepting below, the Patient acknowledges and agrees that complete and accurate health information must be readily available for medical care. Therefore, the Patient authorizes Mend VIP, Inc. or its subsidiaries to release health information to the Patients family physician designated by me or my health plan, referring physician or agency(ies) in order to facilitate continuity of care. The Patient understands that the information shared with health care professionals as a result of this authorization will remain confidential. This authorization shall remain valid while I am using the Mend VIP, Inc. service(s) or 90 days after my visit, whichever is greater.
The Patient agrees that they must be at the designated address provided. If the patient is a minor, a legal guardian or representative must be with the patient during the visit. If the Patient is not at the location and the doctor cannot reach them, the consult may be cancelled. I understand the doctor will wait for 5 minutes and make three attempts to reach the Patient, and after the third attempt, the request for a consult will be cancelled at no charge.
The Patient agrees to disable any anonymous call blocker feature on their phone (*87). To disable anonymous call blocker from a land line, dial *87 on the telephone. For instructions on how to disable anonymous call blocker from a mobile phone, the Patient must refer to their mobile carrier. If the Patient does not disable this feature and the doctor cannot reach them, the consult may be cancelled. The doctor will make three attempts to reach the Patient, and after the third attempt, the request for a consult will be cancelled at no charge.
The Patient understands there is no guarantee the doctor can or will prescribe medication. Mend VIP, Inc. or its subsidiaries does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. The Patient agrees that the pharmacy information provided is correct and current for this consult. Prescriptions cannot be written for international consultations.
By using the Mend VIP, Inc. service(s), you agree that the applications may send you informational text (SMS) messages as part of the normal business operation of your use of the service(s). You may opt-out of receiving text (SMS) messages from Mend VIP, Inc. or its subsidiaries at any time by replying with the word STOP from the mobile device receiving the messages. You acknowledge that opting out of receiving text (SMS) messages may impact your experience with the service(s).
The Patient understands Mend VIP, Inc. or its subsidiaries does not replace the primary care physician. Mend VIP, Inc. or its subsidiaries physicians reserve the right to deny care for potential misuse of services.