TELEMEDICINE CONSENT

I , hereby provide consent for myself to participate in telemedicine consultation with , consultant ophthalmologist at GREWAL EYE INSTITUTE, Chandigarh. I am aware that telemedicine consultation has limitations that the doctors diagnosis and treatment is based on the oral information provided and limited visual inspection of images or videos with inadequate magnification. I have chosen telemedicine consultation because I am unable to attend 'in person consultation' and I am aware that if required, I may still be advised 'in person consultation' at the conclusion of this telemedicine consultation. I agree to make all efforts to undertake the same. I hereby state that I shall not withhold any relevant information/document from the Doctor and I undertake to provide all investigation reports as advised. I also agree to schedule follow up consultation as advised. I also agree that this call may be recorded for record keeping. I may revoke my consent at any time by contacting GREWAL EYE INSTITUTE. As long as this consent is in force, & GREWAL EYE INSTITUTE may provide health care services to me via telemedicine without the need for me to sign another consent form.