Telemedicine Partners Holdings LLC (“FadeMD” OR THE “COMPANY”)
Authorization for Use and Disclosure of Information
Description of Information to be Used and Disclosed: By Agreeing to this Authorization for Use and Disclosure of Information, you authorize FadeMD to use and disclose your: Full Name, Contact Information (Telephone Number, Email Address, Physical Address, Zip Code) (“Contact Information”)
Identification of the Class of Persons to Whom FadeMD can Make the Requested Use and Disclosure of Information: If I choose to Authorize the release of the Contact Information, it will be shared with FadeMD’s partners. Agreeing to this Authorization for Disclosure and Use of Information is optional.
Description of Purpose of the Requested Use and Disclosure of Information: If you agree to this Authorization for Use and Disclosure of Information FadeMD and its partners plan to Use and Disclose the Contact Information for marketing purposes. FadeMD and its partners may send marketing and promotional services about their products and/or services.
Expiration for Use and Disclosure of Information: This Authorization for Use and Disclosure of Information will expire when you revoke it or request to delete your account by messaging info@fademd.com.
Right to Revoke This Authorization for Use and Disclosure of Information: This Authorization for Use and Disclosure of Information can be revoked in writing by emailing info@fademd.com. FadeMD may not condition treatment, payment, enrollment or eligibility for benefits on whether you agree to the authorization. Information disclosed pursuant to this Authorization for Use and Disclosure of Information is subject to redisclosure by the recipient without protection.
Requesting a Copy of this Authorization for Use and Disclosure of Information: If you would like a copy of this Authorization for Use and Disclosure of Information, please send your request to info@fademd.com.
Updated on March 23, 2021