Thank you for choosing Bask Health Inc. (Bask) and Beluga Health, P.A. (“Beluga”)! You are viewing this form because you have elected to engage in asynchronous telemedicine visits with a Beluga healthcare practitioner via Bask. Your practitioner is a board-certified physician licensed in your state.
By clicking “I Agree,” I ACKNOWLEDGE I HAVE READ AND UNDERSTAND THE TERMS PRESENTED BELOW, AND UNDERSTAND THE RISKS AND BENEFITS OF ASYNCHRONOUS TELEMEDICINE, AND BY ACCEPTING THESE TERMS OF USE I HEREBY GIVE MY INFORMED CONSENT TO PARTICIPATE IN ASYNCHRONOUS TELEMEDICINE UNDER THESE TERMS.
Telemedicine is the delivery of healthcare services, including examination, consultation, diagnosis, and treatment, through electronic communication technologies when you (the patient) are located in a different location than your healthcare practitioner. Beluga allows you to receive treatment from a healthcare practitioner without having to travel to another location or schedule a separate appointment and helps you avoid long wait times that you might otherwise experience at an in-person visit.
Asynchronous telemedicine is one way to deliver telemedicine. Asynchronous communication is often
referred to as “store-and-forward” communication, where participants submit and collect data at
different times. An example of asynchronous communication is a telemedicine encounter with a
healthcare practitioner that involves sending photos, video, or other communications via email or text
message. “Asynchronous” means “not occurring at the same time” and is different from “synchronous”
telemedicine, which generally includes visits conducted in real-time between patients and healthcare
practitioners through audio or video means (e.g., live phone calls or video-conferencing). Healthcare
practitioners may use asynchronous telemedicine to aid in diagnoses and medical consultations when
live communication or face-to-face contact is not possible or necessary.
Beluga’s platform (“Platform”), in particular, allows for the following asynchronous telemedicine
services: 1) text-based healthcare practitioner-patient interactions through short message service
(“SMS”) and multimedia messaging service (“MMS”) communications; and 2) secure information collection
through asynchronous store-and-forward patient questionnaires.
What are the Possible Risks to Using Asynchronous Telemedicine?
As with any medical treatment, there are potential risks associated with the use of asynchronous
telemedicine. Beluga believes that the likelihood of these risks materializing is very low.
These risks may include, without limitation, the following:
THE CARE YOU RECEIVE WILL BE AT THE SOLE DISCRETION OF THE HEALTHCARE PRACTITIONER WHO IS TREATING
YOU, WITH NO GUARANTEE OF DIAGNOSIS, TREATMENT, OR PRESCRIPTION. THE HEALTHCARE PRACTITIONER WILL
DETERMINE WHETHER OR NOT THE CONDITION BEING DIAGNOSED AND/OR TREATED IS APPROPRIATE FOR THE CARE
PROVIDED THROUGH AN ASYNCHRONOUS TELEMEDICINE ENCOUNTER VIA THE PLATFORM.
Your Rights and Acknowledgements:
Call/Email/Text Messaging Consent: You expressly consent to allow Beluga or its healthcare
practitioners to call, email, or text you (via SMS and/or MMS) with or regarding Personal Data (as
defined in the Beluga Privacy Policy), appointments, or similar matters related to your telemedicine
encounters using the contact information you have provided. Any calls or texts to you may be placed
using an auto-dialer or a pre-recorded or artificial voice, even if your number is on a do-not-call
list. Your phone carrier’s normal rates may apply. This is consent, not a condition of purchase. You
may revoke this consent at any time by emailing us at [email protected].
This Asynchronous Telemedicine Informed Consent is valid during your entire treatment with Beluga.