Patient Consent

I consent to the treatment and any procedures that may be performed by my medical group, AC Wellness and its affiliated health care providers, including but not limited to laboratory procedures, x-ray examinations, emergency treatment, medical treatment or procedures, anesthesia or other services provided to me. 

I acknowledge that the AC Wellness may arrange for me to connect with healthcare providers using telehealth technologies. I agree to the License Agreement for such use, and understand and agree that:

  • The AC Wellness provider will decide whether it is appropriate to treat my condition using the telehealth technology.
  • The AC Wellness provider may require an in-person examination prior to or after diagnosing or prescribing treatment.
  • The response time for electronic communications varies and I accept any risk associated with the response time, including a delay in obtaining medical care.
  • No warranty or guarantee has been made to me concerning any particular result related to my condition or diagnosis.