Virtual Care Consent Forms

BHRT Health History Form (only required for those doing a consult for BHRT)

BHRT Virtual Consultation Consent Form (only required for those doing a consult for BHRT)

Cosmetic Virtual Consultation Consent Form (only required for those doing a consult for BOTOX, Filler, or Mole Removal)

Cosmetic Health History Form (only required for those doing BOTOX, Filler, or Mole Removal)

Virtual Care has some inherent privacy and security risks that your health information may be intercepted or unintentionally disclosed. We want to make sure you understand this before we proceed. In order to improve privacy and confidentiality, you should also take steps to participate in Virtual Care in a private setting, use an encrypted email service if available, and you should not use an employer’s or someone else’s computer/device as they may be able to access your information. If you want more information, please read below. If it is determined you require a physical exam you may still need to be assessed in person. If you continue,you consent to the use of electronic communication to provide you with care, please advise us that you have reviewed this information and are OK to continue.

Virtual Care (expanded)

COVID-19 is placing stress on Canada’s public health system. Our clinic is starting to offer virtual care to make sure that we can continue to care for our patients safely and effectively. This means that we will be using electronic communications for some patient visits rather than asking all patients to come into our office. Some of these technologies are provided by the Province. Others have been provided by vendors such as Google, or Apple to help make discussions with your care provider as easy as possible during these difficult times. Some health concerns can be addressed with virtual care alone, but in some cases your doctor may ask you to visit a hospital or other health-care facility ,if necessary, for a physical examination. We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no electronic communications tools (such as audio, video, email, text) are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using such electronic communications tools. To help us keep your information safe and secure, you can:

•Understand that electronic communications (such as audio, video, email, text) you receive are not secure in the same way as a private appointment in an exam room.

•Use a private computer/device (i.e., not an employer’s or third party’s computer/device), secure accounts, and a secure internet connection. For example, using a personal and encrypted email account is more secure than an unencrypted email account, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection.

If you are concerned about using electronic communications for virtual care, you can ask our office to attempt to arrange a potential alternative. However, please note that visiting a health care provider in person comes with a higher risk of coming into contact with COVID-19 and the possibility of spreading the virus. By providing your information, you agree to let us collect, use, or disclose your personal health information through video, audio, email, or text communications (while following applicable privacy laws) to provide you with care. In particular, the following means of electronic communication may be used: audio, video(mainly OTN), email, text, etc.