Consent for Online Treatment Template
This legal template is essential for any provider conducting video consultations.
PLEASE NOTE: Once you have submitted your order and your payment is processed, you will receive a separate email within 24 hours with your form included as an attachment. If you have any questions or issues please contact firstname.lastname@example.org
Once payment is received, the Generic Legal Template - Consent for Online Treatment will be sent to you via email.
By completing this purchase you are agreeing to the following Terms of Service:
TEMPLATE FORM AGREEMENT AND DISCLAIMER
Your use of this form is governed by this Agreement.
The Content in this Template Form Does Not Constitute Legal Advice
The Virtual Therapy Center, LLC, operating as Virtual Therapy Connect, (“VTC”) is pleased to provide you with this template form (“Form”). THE INFORMATION PROVIDED IN THE FORM IS NOT LEGAL ADVICE. Please note that health care laws and regulations are complex and change frequently. VTC STRONGLY RECOMMENDS THAT YOU CONSULT A LAWYER TO OBTAIN LEGAL ADVICE CONCERNING THE INFORMATION PROVIDED IN THE FORM, AND THAT THE FORM IS TAILORED TO YOUR PARTICULAR SITUATION.
Use Rights and Limitations
This Form is provided to you on a non-transferable basis. The license to use it is personal to you. You are not allowed to share, give, or provide copies of this Form to anyone for any reason whatsoever, except (1) your legal counsel that will need to tailor them to your particular situation, and (2) individuals or organizations that need to sign the Form. You, along with your legal counsel, are free to make any and all changes to this Form that you believe are appropriate.
WHILE WE HAVE WORKED HARD TO ENSURE THAT THE INFORMATION CONTAINED IN THE FORM IS CORRECT, VTC IS NOT RESPONSIBLE FOR ANY ERRORS OR OMISSIONS, OR FOR ANY CONSEQUENCES FROM THE USE OF THE FORM. THE CONTENT MAY INCLUDE TYPOGRAPHICAL ERRORS OR TECHNICAL INACCURACIES. ALL FORMS ARE PROVIDED “AS IS”, WITH NO GUARANTEE OF COMPLETENESS OR ACCURACY AND WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED INCLUDING, BUT NOT LIMITED TO WARRANTIES OF PERFORMANCE, MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE.
We may terminate your right to use the Form at any time, should we learn that you are using them outside of the scope of the use permitted in this Agreement.
By signing this Agreement and accepting the Form, you understand and agree that you will indemnify and hold VTC harmless from the use of the Form. VTC will not be liable to you for any loss, damage, judgment, award, assessment of costs, expenses, or attorneys’ fees in connection with the use of such Form.
The laws of the State of Virginia govern this Agreement, without reference to its conflicts of laws. The parties consent to personal jurisdiction of the state and federal courts in Virginia. This Agreement is binding and constitutes the entire agreement between the parties and supersedes all previous negotiations, agreements and commitments; it shall only be amended in writing signed by both parties. If any provision of this Agreement is judged to be invalid, illegal or unenforceable, that provision shall be deemed deleted and the remainder will not be affected. All notices will be delivered by electronic mail to us at email@example.com or to you at the email address you have provided to us. This Agreement is not assignable. Any provision of this Agreement that by its nature should survive this Agreement’s termination shall so survive. VTC’s failure to enforce any provision of this Agreement will not be deemed a waiver of the provision or any right under the Agreement. The parties are and will be independent contractors. Neither party will be in default in the performance of this Agreement because of reasons outside of the reasonable control of either party.