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Electronic Medical Consultation
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What do you need to consult about today?
Do you have any medical history?
Do you take any prescription medications, herbs or over the counter medications?
Do you have any medication allergies?
Have you ever had any surgeries?
Have you been hospitalized recently?
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Pharmacy name and phone number where prescription was last filled?
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Additionally, you acknowledge that you understand you’re engaging in an online medical consultation and that you hereby consent to receive healthcare services from one of our medical providers (MD, PA, NP, or DO).
You understand that our healthcare providers reserve the right to deny care for any reason.
You acknowledge that you have a complete understanding of the risks and advantages associated with online medical consultations.
I have read and agree to the informed consent agreement.
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