Telehealth Patient Consent
Due to the COVID-19 Health Crisis and National State of Emergency or other extenuating circumstance, the patient (and/or parent/guardian) was offered an opportunity to have a two-way, live interactive virtual Telehealth assessment with Dr. Klapper. The patient was made aware and verbalized an understanding of the limitations of video conferencing and examination including the challenges associated with visualizing smaller lesions and abnormalities of the eyelids and face and technical limitations due to the patient’s mobile phone camera and wireless connection. The patient (and/or parent/guardian) understands that their insurance and/or Medicare will be billed for this visit; however, the patient may be responsible for some or all of the visit charges either due to standard patient responsibilities (co-pay, deductibles) or because insurance/Medicare deem this telehealth service as “noncovered”. By clicking below and joining the scheduled telehealth visit the patient and/or their parent/guardian agree to a telehealth visit.