Thank you for choosing Zuess Clinicians LLC! You are viewing this form because you are receiving treatment for your sexual health, hair loss, and or improved brain performance from one of our a healthcare practitioners via the Zeuss platform.
By clicking “I Agree,” you acknowledge that you have read, understand, and agree to the following:
Telemedicine is the delivery of healthcare services, including examination, consultation, diagnosis, and treatment, through electronic communication technologies when you (the patient) are located in a different location than a healthcare provider. The Zeuss platform allows you to receive treatment from a physician without having to travel to another location or schedule a separate appointment and helps you avoid long wait times that you might otherwise experience at an in-person visit.
Your healthcare practitioner will conduct your treatment through in-depth questionnaires, review of lab results, and follow up text-based communications through the patient portal. Zuess’s platform does not provide for video or audio visits. Your treatment via telemedicine may include prescriptions, labs, refills, education, and diagnosis.
By clicking “I Agree,” you agree to receive care via telemedicine from [Zeuss Clinicians PC] and the physician above through the Zeuss platform.
As with any medical treatment, there are potential risks associated with the use of telemedicine. Your physician believes that the likelihood of these risks materializing is very low.
These risks may include, without limitation, the following:
This Telemedicine Informed Consent is valid during your entire treatment with your healthcare practitioner via the Zeuss platform.
Authorization of Disclosure of Personal Data
This Authorization will remain in effect until 2050, or until you revoke such authorization in writing, after which Zeuss LLC will no longer be authorized to disclose your medical information until and unless you execute another Authorization.
You have the right to receive a copy of this authorization upon request. Should you wish to receive a copy of this authorization, please send a request to firstname.lastname@example.org."
Healthcare Provider Disclaimer
When the user is connected to a healthcare provider, you should have two pop ups:
1. Emergency disclaimer:
“If you have a life-threatening emergency, DO NOT USE THIS PLATFORM. CALL 911.
By continuing to use the Platform, you are acknowledging that the medical issue for which you are seeking help is not an emergency, life-threatening or critical. Please also note that the healthcare provider’s ability to diagnose and/or treat you may be impaired due to limitations inherent in the technology.”
2. Healthcare provider disclaimer:
“Zeuss LLC is not your healthcare provider. All clinical decisions and provision of health care services are the responsibility of the healthcare provider with whom you are connected via the Platform. You should direct all questions regarding your care to the healthcare provider providing the clinical care.”