Consent to Medical Treatment

I hereby voluntarily consent to receive medical care and treatment from the providers and staff of College Concierge Medical, LLC, including but not limited to:
– Routine diagnostic procedures (e.g., lab work, blood tests)
– Physical examinations and health assessments
– Preventive care, immunizations, and screenings
– Medical treatment for acute or chronic conditions
– Referrals to specialists when necessary
– Administration of medications as prescribed
– Emergency care as needed

I understand that I have the right to refuse or withdraw consent for any treatment at any time, and that my provider will explain the risks, benefits, and alternatives of recommended treatments.

Authorization to Release Information

I authorize the release of medical information to insurance carriers or other healthcare providers involved in my care, as required for billing and coordination of treatment.

Telehealth Consent

I understand that some services may be provided via telehealth (video or phone consultation). I consent to receive medical care via telehealth when appropriate and understand that it may involve limitations in physical examination.

Financial Responsibility

I understand that I am financially responsible for any charges not covered by my subscription, such as medication provided at the appointment.

Acknowledgment

I have read and understood the information above. I have had the opportunity to ask questions and receive answers about my care. I consent to receive treatment from College Concierge Medical, LLC and its healthcare providers.