By signing this document, you are hereby acknowledging that you understand and agree that at the time of your scheduled injury evaluation you must be in a private area with the ability to be hands free. You agree that this evaluation will NOT be conducted from your car, grocery store, or any public place. Please be advised if you are using a smartphone it must be positioned on a stationary object in order to provide you the ability to be hands free. If you breach any of these conditions, the evaluation will not proceed. If it is discovered during the evaluation that a breach of the conditions have occurred, we will immediately terminate the connection.
Additionally, in order to complete this telemedicine injury evaluation, your device must have a good internet connection, speaker, and a microphone.
Lastly, if you are experiencing or have balancing issues, please have someone with you during the evaluation to assist you so as to avoid any further injury.
All documentation provided must be completed prior to the start of the evaluation.