Informed Consent to Telehealth Services and FadeMD Policies
This Telehealth Consent & Privacy Notice (“Consent”) describes the telehealth consent, privacy, and payment-related terms applicable when you use the FadeMD platform. This Consent is provided by Telemedicine Partners LLC, a Florida limited liability company (d/b/a “FadeMD,” “we,” “us,” or “our”), located at:
Telemedicine Partners LLC (d/b/a FadeMD)
936 SW 1st Ave #437
Miami, Florida 33130
Email: info@fademd.com
This Consent includes:
- your consent to receive services delivered using telehealth technology from independent licensed providers who use the FadeMD platform;
- your agreement to participate in telehealth (audio/video/data communications); and
- your acknowledgment of applicable policies and responsibilities, including payment obligations.
By typing your name and clicking “I agree” (or similar) on the FadeMD portal, you agree that you are signing this Consent electronically and that you:
- have reviewed and understand the risks and benefits of telehealth as described below; and
- consent to receive telehealth services from an independent licensed healthcare provider through the FadeMD platform; and
- agree to the remaining terms of this Consent, including the Telehealth Privacy Notice below.
If Signing on Behalf of Another Person
If you are signing on behalf of a minor, incapacitated, or legally dependent patient, you represent and warrant that you have legal authority to act on the patient’s behalf (including authority to consent to medical services) and you accept financial responsibility for services rendered.
The Services are intended for individuals 18+. Where legally permitted, an authorized representative may consent for a legally dependent patient.
1. What Telehealth Is
Telehealth involves delivery of healthcare services—including assessment, consultation, treatment recommendations, and education—using interactive audio, video, and data communications.
Modality by State (FadeMD Platform)
- Pennsylvania: Telehealth encounters may be conducted by interactive video or, where appropriate and permitted, by interactive audio-only (telephone).
- All other states served by FadeMD: Telehealth encounters are conducted by interactive video.
You consent to the modality applicable to your state and the specific encounter, as determined by the provider and permitted by law.
2. Key Disclosures You Understand and Agree To
You understand and agree that:
- Different location from provider. You will not be in the same location or room as the provider during the telehealth encounter.
- Licensure and location accuracy. Your provider is licensed (or otherwise legally authorized) to provide telehealth services to you in the state where you are located at the time of the encounter. You agree to report your location accurately during registration and at the time of service.
- Potential benefits (not guaranteed). Potential benefits may include access to care when in-person visits are difficult, improved convenience, and efficient evaluation for certain conditions. Benefits are not guaranteed.
- Potential risks and limitations. Potential risks include:
- Limited access to in-person diagnostic testing or physical examination;
- Delays or interruptions due to technical failures, connectivity issues, or equipment problems;
- Possible degraded audio/video quality that may affect communication;
- Risks to privacy if technology is compromised or if you participate from an insecure/private location; and
- In rare cases, incomplete transmission or loss of information due to technical failures.
Audio-only additional limitation: If your encounter is audio-only (telephone), you understand there is an additional limitation because the provider cannot observe visual cues, which may further limit assessment.You understand no system can be guaranteed 100% secure and agree you will not hold FadeMD responsible for information loss solely caused by technology failures outside our reasonable control. - Your responsibility to provide accurate information. You understand the provider relies on the information you provide before and during the encounter. You agree to provide information that is complete and accurate to the best of your ability, including medical history, symptoms, and current or prior care.
- Opportunity to ask questions. You may discuss the risks and benefits of telehealth with your provider and will have the opportunity to ask questions.
- Right to withdraw consent. You may withdraw your consent to telehealth or end the session at any time. Withdrawing consent may limit your ability to receive services through the platform, but it will not affect your right to seek care elsewhere.
- Standard of care and referrals. The provider will apply the appropriate standard of care. If the provider believes you would be better served by in-person services or another form of care, you may be advised to seek in-person care, urgent care, or emergency services, as appropriate.
3. Emergencies
Telehealth is not for emergencies.
If you have an emergency, call 911 or go to the nearest emergency room immediately.
4. Treatment Consent (Provider Services)
You consent to, understand, and agree that:
- You have the right to discuss the risks and benefits of proposed treatment options and available alternatives with your provider.
- Your provider will use professional judgment consistent with applicable standards of care and law, but no outcomes are guaranteed.
- Your provider’s advice, recommendations, and clinical decisions are based on the information available, including information you provide.
No provider-patient relationship with FadeMD.
Any provider-patient relationship is between you and the independent licensed provider, not FadeMD. FadeMD provides technology and administrative services that support telehealth encounters.
5. Medical Records
You have the right to request access to and copies of your medical records, subject to applicable law and the provider’s policies and procedures. Records may include information obtained during a telehealth encounter.
6. Applicable Law
The laws of the state where you are located at the time you receive telehealth services generally apply to the telehealth services you receive, including professional licensure and scope-of-practice requirements.
7. Payment Responsibility
You agree to pay all charges that are your responsibility for services requested. If fees are collected through the FadeMD portal, you authorize the charge to your payment method for the amounts disclosed at the time you request services.
If a Third-Party Provider or other third party charges separately (depending on the service and jurisdiction), you may be responsible for those charges as disclosed.
8. Telehealth Privacy Notice
We take privacy seriously and will protect your information as described in our Privacy Policy, available here:
https://fademd.com/privacy-policy
By signing this Consent, you acknowledge that you have access to the Privacy Policy and consent to the collection, use, and disclosure of information as described therein.
You understand that confidentiality protections that apply to in-person treatment generally also apply to telehealth services, though telehealth introduces additional privacy risks described above (e.g., technology and environment).
9. Acknowledgment and Electronic Signature
By typing your name and clicking “I agree” (or similar), you acknowledge that:
- you have read and understood this Consent;
- you have had the opportunity to ask questions;
- you consent to receive telehealth services as described (including the modality applicable to your state and encounter); and
- you agree to the Telehealth Privacy Notice and applicable policies.
Date of Consent: (captured electronically)
