Patient Consent and Agreements
TeleHealth Informed Consent
Telehealth is healthcare provided by any means other than an in person, face to face visit. In telehealth services, medical information is used for diagnosis, consultation, treatment, follow up and education. Health information is exchanged interactively from one side to another through electronic communications. Telephone consultation, videoconferencing, transmission of still images, e-health technologies, patient portals, and remote patient monitoring are all considered telehealth services.
I understand that electronic communication should never be used for emergency communications or urgent requests. Emergency communications should be made to the existing emergency 911 services in my community.
- I understand that telehealth involves the communication of my medical information in an electronic or technology-assisted format.
- I understand that I may opt out of the telehealth visit at any time. This will not change my ability to receive future care at this office.
- I understand that telehealth billing information is collected in the same manner as a regular office visit. My financial responsibility will be determined individually.
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I understand that all electronic medical communications
carry some level or risk. While the likelihood of risks
associated with the use of telehealth in a secure
environment is reduced, the risks are nonetheless real and
important to understand. These risks include but are not
limited to:
- It is easier for electronic communication to be forwarded, intercepted, or even changed without my knowledge and despite taking reasonable measures.
- Electronic systems that are accessed by employers, friends, or others are not secure and should be avoided. It is important for me to use a secure network.
- Despite reasonable efforts on the part of my healthcare provider, the transmission of medical information could be disrupted or distorted by technical features.
- I agree that information exchanged during my telehealth visit will be maintained by the providers, other healthcare providers and healthcare facilities involved in my care.
- I understand that I must take reasonable steps to protect myself from unauthorized use of my electronic communications by others.
- The healthcare provider is not responsible for breaches of confidentiality caused by an independent third party or by me.
- I agree that I have verified my healthcare provider, my identity and current location in connection with the telehealth services. I acknowledge that failure to comply with these procedures may terminate the telehealth visit.
- I understand that I have a responsibility to verify the identity and credentials of the healthcare provider rendering my care via telehealth and to confirm that he or she is my healthcare provider.
- I understand that electronic communication cannot be used for emergencies or time-sensitive matters.
- I understand that my healthcare provider may choose to forward my information to an authorized third party. Therefore, I have informed the healthcare provider of any information I do not wish to be transmitted through electronic communications.
- By beginning the visit, I understand the inherent risks of errors or deficiencies in the electronic transmission of health information and images during a telehealth visit.
- I understand that there is never a warranty or guarantee as to a particular result or outcome related to a condition or diagnosis when medical care is provided.
- To the extent permitted by law, I agree to waive and release my healthcare provider and his or her institution or practice from any claims I may have about the telehealth visit.
- I certify that I have read and understand this agreement and that I have had the opportunity to have questions answered to my satisfaction.
- I understand that I have the right to access my health information and copies of my medical records in accordance with Florida state law.
I have read and understand the information provided above. I have discussed it with my healthcare provider and all of my questions have been answered to my satisfaction. My signature below indicates my informed and willful consent to treatment using this platform.
NOTICE OF PRIVACY PRACTICES ACKNOWLEGEMENT
I understand that under Health Insurance Portability & Accountability Act of 1996 (“HIPPA”), I have certain rights to privacy regarding my protected health information. I understand that this information can and will be used to:
- Conduct, plan and direct my treatment and follow-up among the multiple healthcare providers, who may be involved in that treatment directly and indirectly.
- Obtain Payment from third-party payers
- Conduct normal healthcare operations such as quality assessments and physician’s certifications.
I have received, read and understand the Notice of Privacy Practices containing a more complete descriptions of the uses and disclosures of my health information. I understand that the organization has the right to change is Notice of Privacy Practices from time to time and that I may contact the organization (The U.S. Department of Health & Human Services) at its toll free number 1-877-696-6775 at any time to obtain a current copy of the Notice of Privacy Practices.
I understand that electronic communication should never be used for emergency communications or urgent requests. Emergency communications should be made to the existing emergency 911 services in my community.
FINANCIAL AGREEMENT FOR SERVICES
Upon scheduling your first appointment you will be required to have a debit or credit card placed on file for future charges. Your card will be billed on the same calendar day each month. Our services do not participate in or accept any form of insurance, including Medicare/Medicaid. Additionally, we are not approved for payments through Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA).
AGREEMENT TO PAY: I, the undersigned, acknowledge and accept the fee charged as a valid and enforceable debt. I agree to pay the total amount due, including, if a debt is overdue, any associated collection fees (33.33% of the total owed), attorney fees, and court costs if necessary. I hereby waive any rights to claim exemptions under the laws of the Constitution of the State of Florida or any other state.
EXPRESS PRIOR CONSENT TO CONTACT CONSUMER BY CELL PHONE:
You agree, in order for us to service your account or to collect monies you may owe, Slims and/or our agents may contact you by telephone at any telephone number associated with your account, including wireless telephone numbers, which could result in charges to you. We may also contact you by sending text messages or emails, using any email address you provide to use. Methods of contact may include using pre-recorded/artificial voice messages and/or use of automatic dialing device, as applicable.
We genuinely understand that there may be times when your purchase doesn’t fully meet your expectations, and your satisfaction is incredibly important to us. While we’re unable to accept returns due to the nature of our products, we warmly invite you to reach out if you’re not completely happy with your order. Your feedback means a great deal to us, and we’re here to do everything we can to address any concerns and ensure a positive experience for you.
My signature below indicates that I have read this disclosure and agree that Slims, its employees and/or agents may contact me/us as described above.
CANCELLATION AND NO-SHOW POLICY
At Slims, we are committed to providing high-quality care and respecting your time, and we kindly ask that you do the same in return. The following policy outlines our terms regarding cancellations and no-shows for consultations:
If you do not attend a scheduled consultation and fail to notify us in advance, it will be considered a no-show. Please note that no refunds will be issued for missed or no-show consultations.
We understand that circumstances may arise that require you to reschedule. If you are within the first 30 days of your initial membership signup, you may reschedule your consultation at no additional cost. To do so, please contact us at least 24 hours before your scheduled consultation to make new arrangements.
Your understanding and cooperation help us serve all of our members effectively. If you have any questions or need assistance with rescheduling, please feel free to reach out to us through your personal portal or by calling us at [phone].
WEIGHT LOSS PROGRAM CONSENT FORM
I authorize Slims to help me in my weight reduction efforts. I understand that my program may consist of a balanced-deficit diet, a regular exercise program, instruction on behavior modification techniques, and may involve the use of weight management medications. Other treatment options may include a very low-calorie diet, or a protein-supplemented diet. I further understand that if medications are used, they may be used for durations exceeding those recommended in the medication package insert. It has been explained to me that these medications have been used safely and successfully in private medical practices as well as in academic centers for periods exceeding those recommended in the product literature.
I understand that any medical treatment may involve risks as well as the proposed benefits. I also understand that there are certain health risks associated with remaining overweight or obese. Risks of this program may include but are not limited to nervousness, sleeplessness, headaches, dry mouth, gastrointestinal disturbances, weakness, tiredness, psychological problems, high blood pressure, rapid heartbeat, and heart irregularities. These and other possible risks could, on occasion, be serious or even fatal. Risks associated with remaining overweight are tendencies to high blood pressure, diabetes, heart attack and heart disease, arthritis of the joints including hips, knees, feet and back, sleep apnea, and sudden death. I understand that these risks may be modest if I am not significantly overweight, but will increase with additional weight gain.
I understand that much of the success of the program will depend on my efforts and that there are no guarantees or assurances that the program will be successful. I also understand that obesity may be a chronic, lifelong condition that may require changes in eating habits and permanent changes in behavior to be treated successfully.
I have read and fully understand this consent form and I realize I should not sign this form if all items have not been explained to me. My questions have been answered to my complete satisfaction. I have been urged and have been given all the time I need to read and understand this form. If you have any questions regarding the risks or hazards of the proposed treatment, or any questions concerning the proposed treatment or other possible treatments, ask your doctor now before signing this consent form.
Terms & Conditions
OVERVIEW
This website is operated by Slims. Throughout the site, the terms “we,” “us,” and “our” refer to Slims. Slims provides this website, including all information, tools, and services available from this site to you, the user, conditioned upon your acceptance of all terms, conditions, policies, and notices stated here.
By visiting our site and/or purchasing something from us, you engage in our “Service” and agree to be bound by the following terms and conditions (“Terms of Service,” “Terms”), including any additional terms and policies referenced herein and/or available by hyperlink. These Terms of Service apply to all users of the site, including without limitation users who are browsers, vendors, customers, merchants, and/or contributors of content.
Please read these Terms of Service carefully before accessing or using our website. By accessing or using any part of the site, you agree to be bound by these Terms of Service. If you do not agree to all the terms and conditions of this agreement, you may not access the website or use any services. If these Terms of Service are considered an offer, acceptance is expressly limited to these Terms of Service. Any new features or tools added to the current platform shall also be subject to the Terms of Service. You can review the most current version of the Terms of Service at any time on this page. We reserve the right to update, change, or replace any part of these Terms of Service by posting updates and/or changes to our website. It is your responsibility to check this page periodically for changes. Your continued use of or access to the website following any changes constitutes acceptance of those changes.
GENERAL CONDITIONS
We reserve the right to refuse service to anyone for any reason at any time. You understand that your content (not including credit card information) may be transferred unencrypted and involve (a) transmissions over various networks and (b) changes to conform and adapt to technical requirements of connecting networks or devices. Credit card information is always encrypted during transfer over networks. You agree not to reproduce, duplicate, copy, sell, resell, or exploit any portion of the Service, use of the Service, or access to the Service without express written permission by us. Headings in this agreement are included for convenience only and do not limit or otherwise affect these Terms.
ACCURACY, COMPLETENESS, AND TIMELINESS OF INFORMATION
We are not responsible if information on this site is not accurate, complete, or current. The material on this site is for general information only and should not be relied upon as the sole basis for decision-making without consulting primary, more accurate sources of information. Any reliance on the material on this site is at your own risk. This site may contain certain historical information, provided for reference only. We reserve the right to modify the content of this site at any time, but we have no obligation to update any information on our site. You agree that it is your responsibility to monitor changes to our site.
MODIFICATIONS TO THE SERVICE AND PRICES
Prices for our products are subject to change without notice. We reserve the right to modify or discontinue the Service (or any part thereof) without notice. We shall not be liable to you or any third party for any modification, price change, suspension, or discontinuance of the Service.
PRODUCTS OR SERVICES (if applicable)
Certain products or services may be available exclusively online. These products or services may have limited quantities and are subject to return or exchange according to our Return Policy. We have made every effort to display products accurately. However, we cannot guarantee that your computer monitor's display of any color will be accurate. We reserve the right to limit sales of our products or services to any person, geographic region, or jurisdiction. This may be exercised on a case-by-case basis. Descriptions and pricing of products are subject to change without notice. We reserve the right to discontinue any product or service at any time.
ACCURACY OF BILLING AND ACCOUNT INFORMATION
We reserve the right to refuse any order you place. We may limit or cancel quantities purchased per person, per household, or per order. These restrictions may include orders placed under the same customer account, credit card, and/or billing and shipping address. We will notify you if we make changes to or cancel an order. You agree to provide current, complete, and accurate purchase and account information for all transactions. Promptly update your account and other information, including email address, credit card numbers, and expiration dates, to complete your transactions and contact you as needed.
OPTIONAL TOOLS
We may provide you with access to third-party tools over which we neither monitor nor control. You acknowledge that we provide these tools "as is" and "as available," without warranties, representations, or conditions of any kind. Any use of third-party tools is entirely at your own risk, and you should ensure that you are familiar with and approve of the terms provided by the relevant third-party providers. We may also offer new features or services, which will be subject to these Terms of Service.
THIRD-PARTY LINKS
Some content, products, and services available via our Service may include third-party materials. Third-party links on this site may direct you to websites not affiliated with us. We are not responsible for examining or evaluating third-party content or accuracy and will not be liable for third-party materials or websites. Please review third-party policies before engaging in any transaction. Complaints regarding third-party products should be directed to the third party.
USER COMMENTS, FEEDBACK, AND OTHER SUBMISSIONS
If you send creative ideas, suggestions, or other materials to us, you agree that we may use them in any medium without restriction. We are under no obligation to (1) maintain comments in confidence, (2) pay compensation, or (3) respond. We may monitor or remove content we find unlawful, offensive, or otherwise objectionable, but are not obligated to do so.
PERSONAL INFORMATION
Your submission of personal information is governed by our Privacy Practices.
ERRORS, INACCURACIES, AND OMISSIONS
Occasionally, there may be typographical errors, inaccuracies, or omissions related to product descriptions, pricing, or availability. We reserve the right to correct errors and update information or cancel orders at any time. We undertake no obligation to update information unless required by law.
PROHIBITED USES
You are prohibited from using the site or its content:
- for any unlawful purpose;
- to solicit others to perform unlawful acts;
- to violate any laws;
- to infringe upon intellectual property rights;
- to harass, abuse, or discriminate;
- to upload viruses or malicious code;
- to collect or track others’ information;
- for obscene or immoral purposes; or
- to interfere with security features.
We reserve the right to terminate your use of the Service for violating prohibited uses.
DISCLAIMER OF WARRANTIES; LIMITATION OF LIABILITY
We do not guarantee that the use of our service will be uninterrupted or error-free. Your use of the service is at your sole risk. The Service and products are provided "as is" and "as available," without warranties of any kind. Slims, its directors, employees, and affiliates shall not be liable for any damages resulting from the use of the service, including indirect, incidental, or consequential damages.
INDEMNIFICATION
You agree to indemnify Slims and its affiliates from any claims arising out of your violation of these Terms of Service or your use of the Service.
SEVERABILITY
If any part of these Terms is deemed unlawful or unenforceable, that portion shall be severed, and the remainder will remain enforceable.
TERMINATION
These Terms remain in effect until terminated by either you or us. We may terminate your access to the Service without notice if you fail to comply with these Terms.
ENTIRE AGREEMENT
These Terms constitute the entire agreement between you and Slims, superseding prior agreements or communications.
GOVERNING LAW
These Terms shall be governed by the laws of Florida.
REFUND POLICY
Slims membership: We cannot provide refunds once a payment is made, except for first-time payments before assessment by a Slims provider.
Medications: Refunds are not available once medication has been ordered.
Pre-paid Lab Requisitions or Kits: Refunds are not available once the lab requisition has been generated or the kit ordered.
To request a refund, contact us at support@withslims.com.
CONTACT INFORMATION
For questions regarding these Terms, contact us at support@withslims.com.
NOTICE OF PRIVACY PRACTICES
At Slims ("we," "us," or "our"), your privacy and the security of your personal health information (PHI) are our top priorities. This Privacy Policy explains how we collect, use, disclose, and protect your PHI in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the Florida Information Protection Act (FIPA), and other applicable Florida state laws. By receiving services from us, you consent to the practices described in this Privacy Policy.
Information We Collect
We collect the following types of information:
- Personal Health Information (PHI): Includes your name, date of birth, address, medical history, diagnosis, treatment information, laboratory results, and other health-related data.
- Payment Information: Includes credit/debit card details and billing information.
- Communications: Records of your communications with us, including emails, phone calls, and other interactions.
How We Use Your Information
We may use your information for the following purposes:
- Treatment: We use your PHI to provide and coordinate your medical care, including consulting with healthcare providers, managing prescriptions, and evaluating your health needs.
- Payment: We use and disclose your information to process payment for services rendered.
- Healthcare Operations: We use PHI to improve the quality of care we provide, conduct internal audits, and for administrative purposes.
- Compliance with Laws: We may use or disclose your information as required by federal and state law, including reporting to public health authorities or responding to legal requests.
How We Share Your Information
We may disclose your PHI under the following circumstances:
- With Your Consent: We will obtain your written consent before sharing your information for non-treatment purposes.
- Healthcare Providers: We may share your PHI with other healthcare professionals involved in your care.
- Payment Processors: We may disclose your information to billing companies, or other entities for payment purposes.
- Legal Requirements: We may disclose your PHI to comply with a legal obligation, such as responding to a court order, government investigation, or subpoena.
- Public Health and Safety: We may disclose your PHI for public health reasons, such as preventing disease outbreaks or addressing health and safety concerns.
- Business Associates: We may disclose your PHI to third-party business associates who provide services on our behalf, such as billing or data processing. These associates are required to protect your information in accordance with HIPAA and Florida law.
Your Rights Regarding Your PHI
As a patient, you have the following rights under HIPAA and Florida law:
- Right to Access: You can request copies of your medical records or other health information we maintain, in line with Florida Statutes Section 456.057, which governs the release of medical records. We may charge a reasonable fee for copies in accordance with Florida law.
- Right to Amend: If you believe that your information is inaccurate or incomplete, you can request that we correct or amend it.
- Right to Restrict Disclosures: You can request that we limit the use or disclosure of your PHI for treatment, payment, or healthcare operations. We will honor your request unless it is not feasible or legally required.
- Right to Confidential Communications: You can request that we communicate with you in a specific manner (e.g., through phone calls or secure emails).
- Right to an Accounting of Disclosures: You can request a report detailing how your PHI has been disclosed.
- Right to File a Complaint: If you believe your privacy rights have been violated, you have the right to file a complaint with our office or with the U.S. Department of Health and Human Services (HHS). You can also file a complaint with the Florida Department of Health.
Data Security
We take the protection of your personal health information seriously. We implement appropriate administrative, technical, and physical safeguards to protect your information from unauthorized access, use, or disclosure, as required by HIPAA, FIPA, and other Florida laws. These measures include encryption, secure data storage, and staff training on HIPAA and Florida state compliance.
Breach Notification
In the event of a breach that compromises the privacy or security of your PHI, we will notify you as required under HIPAA and the Florida Information Protection Act (FIPA). Florida law requires that we notify affected individuals within 30 days of a data breach. Notifications will include information about the breach, steps we have taken to address it, and what you can do to protect yourself.
Minors’ Privacy
The Site is not intended for individuals under the age of 18.
Changes to This Privacy Policy
We reserve the right to update this Privacy Policy at any time. Any changes will be posted on our website with the updated effective date. We encourage you to review this policy periodically to stay informed about how we protect your privacy.
Contact Us
If you have any questions or concerns about this Privacy Policy
or how we handle your PHI, please contact us at:
support@withslims.com.
