Electronic Telehealth Consent Form

To receive telehealth services with our company, we require a signed consent form. Please complete the form at the link below.

Complete the Electronic Telehealth Consent Form

Instructions for completing the form:

• Click the link above to open the secure consent form.

• Fill in all required fields, including your personal and contact information.

• Read each section carefully before signing.

• Provide your electronic signature where requested.

• Submit the form once complete.

You will receive a confirmation message once your form has been successfully submitted. If you have any questions or experience any issues, please contact our office directly for assistance.