Consent to Receive Telehealth Services
Nature of Telehealth: I understand that telemedicine involves the use of synchronous audio, video, or other electronic communications to interact with a physician who is not in the same physical location. I consent to both video synchronous interaction and audio-only interaction should broadband limitations require a modality switch.
Voluntary Participation: I understand that my participation is entirely voluntary, and I may withdraw my consent to telehealth services at any time without affecting my right to access future care.
Right to In-Person Care: I understand that I have the right to access covered medical services in person. Med Now MD operates exclusively as a virtual practice; if an in-person physical examination is deemed medically necessary, my provider will arrange for a referral to appropriate in-person care at a local clinic, urgent care, or emergency department.
Limitations of Virtual Care: I understand that there are inherent limitations to virtual care, primarily the inability of the physician to perform a hands-on physical examination. Technological failures may interrupt the visit, and I agree to hold the practice harmless for disruptions caused by software, hardware, or broadband connectivity malfunctions.
Consent for Unencrypted Communication (SMS/Text): I consent to receive text messages (SMS) and emails from Med Now MD regarding my care, billing, and triage. I understand that standard SMS texting and regular email are not secure, encrypted methods of communication. I acknowledge there is a risk that my Protected Health Information (PHI) could be intercepted or viewed by unauthorized third parties. I accept this risk and agree to hold Med Now MD harmless for any unauthorized access to information transmitted via these unsecure channels.
Emergency Protocols: I explicitly agree that I will not utilize Med Now MD for life-threatening emergencies. If I experience a medical emergency, I will immediately call 911 or proceed to the nearest emergency room.
Notice of Privacy Practices
Effective Date: April 1, 2026
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Our Legal Responsibilities
Med Now MD is required by federal and state law to maintain the privacy and security of your protected health information (PHI). We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information. We must follow the duties and privacy practices described in this notice and provide you with a copy of it.
How We May Use and Share Your Health Information
- Treatment: We can use your health information and share it with other healthcare professionals who are treating you. Example: A specialist treating you for a specific condition asks us about your overall health or a pharmacy requires clarification on a prescription.
- Health Care Operations: We can use and share your health information to run our practice, improve your care, and contact you when necessary. This includes storing data securely within our audited Google Workspace infrastructure.
- Payment & Cash-Pay Status: Med Now MD is a direct-pay practice. Because you pay for our services out-of-pocket in full, you have the right to ask us not to share that information with your health insurer for the purpose of payment or our operations. We will honor this request unless a law requires us to share that information.
Special Protections
- Substance Use Disorder (SUD) Records: Pursuant to the 42 CFR Part 2 Final Rule effective February 16, 2026, records pertaining to the treatment of substance use disorders receive heightened protections. These records generally require your explicit written consent for disclosure, except in specific medical emergencies or as mandated by court order.
- Reproductive Health Privacy: We will not use or disclose your PHI for the purpose of investigating or imposing liability on any person for seeking, obtaining, providing, or facilitating lawful reproductive health care.
Your Rights
You have the right to request an electronic or paper copy of your medical record, request corrections, request confidential communications, ask us to limit what we use or share, obtain a list of those with whom we have shared your information, and choose someone to act on your behalf.
Financial Responsibility & Cash-Pay Agreement
Direct-Pay Practice: I understand that Med Now MD is a direct-pay, cash-only medical practice. The practice does not participate in any commercial health insurance networks, HMOs, PPOs, Medicaid, or Medicare.
Payment Due at Service: I agree that payment in full is required at the time of booking or prior to the initiation of any clinical services.
No Insurance Billing: I understand that Med Now MD will not submit claims to any health insurance provider on my behalf.
Superbills and Reimbursement: Upon request, Med Now MD will provide me with an itemized receipt containing diagnostic (ICD-10) and procedural (CPT) codes, commonly known as a "superbill". I understand that providing this superbill does not guarantee that my insurance carrier will reimburse me for the cost of the visit. I am solely responsible for submitting the superbill to my insurance company and negotiating any potential out-of-network reimbursement.
Concierge Practice Membership Agreement
1. The Program: Med Now MD (the "Practice") offers a premium concierge membership tier (the "Program") designed to provide dedicated, frictionless access to an expert physician for acute triage and care coordination.
2. Scope of Clinical Services: The monthly membership fee ($126.00 for Individual or $250.00 for Family) covers the following clinical and administrative amenities:
- Priority asynchronous text and voice note triage via the Spruce Health application.
- Seamless prescription management and rapid refills.
- Medical clearance fees waived on all contracted mobile IV therapies.
3. Exclusions of Medical Services: This membership serves as a supplemental safety net for standard urgent complaints and high-acuity triage. It does not replace a Primary Care Physician. The Practice does not provide routine wellness exams, vaccinations, chronic disease management (e.g., managing hypertension or diabetes), or routine laboratory screening.
4. Term and Termination: This agreement is inherently month-to-month. Either party may terminate this agreement with thirty (30) days written notice.
5. Recurring Credit Card Payment Authorization: I authorize Med Now MD to securely store my payment credentials and automatically charge my credit card on file each month for my ongoing Concierge Membership fee. I understand that this authorization will remain in effect until I cancel it in writing. I certify that I am an authorized user of this credit card and that I will not dispute the scheduled payments with my credit card company or banking institution provided the transactions correspond to the terms indicated in this agreement.