Schedule a Telemedicine Video Consultation

Schedule a Video Consultation with Dr.Verdi, Dr.Botros, Dr.Discepola or Dr.DeLorenzo

1. New Patients Only- Download all Required Forms including Telemedicine Terms of Use
2. Existing Patients- Download or Digitally Sign the Telemedicine Terms of Use
3. To Schedule appointment after forms complete, please put in First & Last Name, Cell Phone number you would like to be contacted on, Email and Requested Appointment Date & Time OR CALL 973-731-1266 TO BOOK WITH STAFF.
4. At the time of the appointment, you will receive a text to confirm your identity by inputting your Name and Date of Birth then hit confirm. Stay on the screen where you just hit confirm and text “Ready” and then answer green telephone button to start video consultation

What is Telemedicine?

How does it work?

Telemedicine is the use of telecommunications technology to provide real-time health care to patients at a distance.

How is telemedicine delivered?

Telemedicine can be delivered using video-conferencing, audio communication, and/or text-messaging using mobile phones, tablets, and desktop computers.

Who participates in telemedicine?

Healthcare professionals can use telemedicine to see patients or to consult with other care providers

What can telemedicine be used for?

Telemedicine has many applications in healthcare, including standard clinical care, counseling or therapy, patient education, professional consultant or supervision, and more.

Where can telemedicine be provided?

Telemedicine can be provided to a patient at home or work, or at another clinic or hospital. Now with mobile devices, you or the patient can be anywhere with access to the internet.

Terms of Use: Effective 03/18/2020

Please do not use this site for emergency medical needs. If you experience a medical emergency, call 911 immediately!

Privacy

You acknowledge that you are consenting to receiving care via telemedicine/telehealth. The scope of care will be at the sole discretion of FOOT HEALTH CENTER, LLC / Dr. Michael Verdi, Dr. Merihan Botros, Dr. Doug DeLorenzo or Dr.Kirsten Discepola who is treating you, with no guarantee of diagnosis, treatments, or prescription. FOOT HEALTH CENTER, LLC/ Dr. Michael Verdi, Dr. Merihan Botros, Dr. Doug DeLorenzo or Dr.Kirsten Discepola will determine whether or not the condition being diagnosed and/or treated is appropriate for a telehealth encounter. You understand and agree that your interaction is not intended to take the place of any face-to-face appointments, when possible.

Informed consent for services performed via telehealth/telemedicine

The delivery of healthcare through services using communication tools such as a cell/telephone, live twoway audio and video, remote patient monitoring, or other electronic means, is called “telemedicine”. Telemedicine involves the use of electronic communications to enable healthcare providers who are remote from patients to provide care and services. The information gathered/accessed may be used for diagnosis, treatment, follow-up, therapy or education and may include information from existing medical history or records.

The communication systems used will incorporate network and software security protocols to protect your confidentiality and will include measures to secure the data against intentionally/unintentional corruptions or access. It is your responsibility to be in a secure/private location where your telehealth encounter can occur. Do not use telehealth services in a public location, or on a public computer.

As with office-based face-to-face visits, a visit summary will be made available to you if you request. This summary can be kept for your records or shared with another healthcare provider of your choosing (e.g., specialist or other provider).

Benefits of Telemedicine

• Improved and increased access to care remotely.
• More efficient medical evaluation and management.
• Convenient

Possible Risks of Telemedicine

As with any medical visit, office based or otherwise, there are potential risks associated. The risks may include:

• Delays in medical evaluation and consultation or treatment due to deficiencies or failure of technology:
• In very rare instances, unanticipated breach in security protocols-poor security controls:
• In rare cases, a lack of access to complete or comprehensive medical records, resulting in adverse drug interaction, allergic reactions, or other negative outcomes;
• Patient must disclose comprehensive/complete medical and medication history.

How to Receive Follow up Care

Call our office at 973-731-1266 or visit our website www.foothealthcenter1.com If at any time during the telehealth visit:

• You experience a health emergency and feel you need immediate care, please inform the healthcare provider, it may be necessary to call 911 and you may be directed to the nearest hospital/emergency room
• You or your healthcare provider experience telecommunication or equipment failure that prohibits the completion of visit, please contact the office directly to be connected to afterhours call line and the healthcare provider.

By agreeing to these Terms of Use and by accepting Online Telemedicine/Telehealth Services you agree and understand the following:

1. The laws that protect privacy and confidentiality of medical information also apply to telemedicine/telehealth and that no information obtained in the use of telemedicine which identifies me will be disclosed to researchers or other entities without my consent.
2. That you have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.
3. That telemedicine involves electronic communications of my personal health information.
4. You may expect the anticipated benefits from the use of telehealth in your care but results from care/treatment cannot be guaranteed or assured.
5. My healthcare provider has the right to discontinue at any time if he/she feels it is necessary or that an in-person visit is necessary.
6. Your health information may be shared with other individuals for treatment, payment and healthcare purposes.

1. Psychotherapy notes are maintained by the telemedicine healthcare clinician, but not shared with others. Only billing codes and visit summaries with be shared with others and you.
2. If you obtain psychotherapy services, you understand that your therapist has the right to limit the information provided to you, if in the therapist professional judgement sharing the information with you would be harmful to you.

1. Your healthcare information may be shared in the following circumstances:

1. A valid court order is issued for medical records
2. Reporting suspected abuse, neglect or domestic violence
3. Preventing or reducing serious threats to anyone’s’ health or safety

Charges for Services

You understand and agree that you are responsible for all charges related to your telehealth visit. You will pay for all services provided and agree that the charges are valid and appropriate.

Patient Consent to the Use of Telemedicine

Consent

By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.