jrosenhein.groundedtelehealth@gmail.com
(423) 430-7629
jrosenhein.groundedtelehealth@gmail.com
(423) 430-7629
CONSENT: Care under Jacqueline Ramsey-Rosenhein DNP, FNP-BC
****IF YOU RESIDE IN A STATE THAT REQUIRES A VIDEO OR PHONE VISIT TO ESTABLISH CARE BEFORE TREATMENT:
By signing this form, I certify:
• That I have read or had this form explained/read to me and I understand its contents including the risks and benefits of telemedicine.
• That I have had the opportunity to ask questions and have had them answered to my satisfaction.
I AM AGREEING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.
Booking an appointment confirms you are in agreement to all items in this consent.