Teleconsultation Consent Form

By proceeding with the service, I declare that I have read, understood, and fully agree to the terms below:

1. About the Teleconsultation

I declare that I have been informed that the medical consultation will be conducted remotely, through digital technology (online chat or video call), in accordance with the current regulations of the Federal Medical Council.

I understand that:

Teleconsultation carries the same ethical and legal responsibilities as an in-person consultation;
Remote care may have limitations due to the absence of a physical examination;
The physician may, at any time, recommend an in-person evaluation, additional tests, or referral to another healthcare service if deemed necessary for proper clinical assessment.

2. About Prescription Renewal

I acknowledge and agree that:

Prescription renewal is not automatic;
All prescriptions are issued only after an individual medical evaluation;
The physician may refuse to renew a prescription if clinical criteria are not met or if further evaluation is required;
An in-person consultation or additional tests may be recommended before issuing a new prescription.

3. Confidentiality and Data Protection

I authorize the processing of my personal data and sensitive health data exclusively for the following purposes:

Provision of medical care;
Issuance of digital prescriptions;
Maintenance of electronic medical records;
Compliance with legal, regulatory, and ethical obligations applicable to medical practice.

I understand that my data will be processed in accordance with applicable data protection laws, ensuring confidentiality, security, and restricted use strictly related to medical care.

4. Digital Prescription

I understand that:

Medical prescriptions may be issued in digital format;
The document may include a certified digital signature, in accordance with applicable regulations;
Acceptance of digital prescriptions may depend on pharmacy policies or specific rules related to the prescribed medication.

5. Responsibility for Provided Information

I declare that all information provided during the consultation, including medical history, symptoms, previous diagnoses, medication use, and other health-related data, is true, complete, and up to date, and I am fully responsible for its accuracy.

I understand that medical evaluation and decisions will be based on the information I provide, and that omissions or incorrect information may compromise proper clinical assessment and medical guidance.

6. Technical Limitations of Remote Care

I acknowledge that remote medical services may be subject to technological limitations, including internet instability, communication failures, system unavailability, or platform interruptions.

If technical issues prevent proper continuation of the consultation, the service may be interrupted, rescheduled, or continued through another available means, at the discretion of the responsible professional.

7. Post-Consultation Support

After the consultation, the patient may contact support within up to 7 (seven) calendar days exclusively to clarify questions related to the issued prescription or to report difficulties in obtaining the medication.

This support does not constitute a new medical consultation and is limited to administrative or technical clarifications regarding the issued prescription.

Questions related to the evolution of the clinical condition, new symptoms, need for reassessment, treatment adjustments, medication changes, or new medical guidance will be considered a new consultation and may be subject to additional charges according to current pricing.

8. Cancellation, Rescheduling, and Refund Policy

The patient may request cancellation of the scheduled service up to 2 (two) hours before the appointment time, with a full refund guaranteed.

Cancellation requests made less than 2 (two) hours in advance are not eligible for a refund. In such cases, a one-time rescheduling option may be offered, limited to the same day or the following day, subject to availability.

In case of no-show, the amount paid will not be refunded.

Once the medical consultation has been completed, cancellation or refund requests will not be accepted, as the service has already been fully provided.

9. Scope Limitations

I understand that this service is not intended for medical emergencies or urgent situations.

In case of severe symptoms, sudden worsening of the condition, or any situation posing an immediate health risk, I must seek immediate in-person medical care at an emergency service.

By using this service, I declare that:

I have read, understood, and agree with all the information described in this document;
I authorize the teleconsultation;
I authorize, when clinically appropriate, the issuance of a digital medical prescription.