Consent for Services

I voluntarily consent to medical care provided by Occupational Medicine Physicians, which may include diagnostic tests, procedures, or treatments as prescribed by my physician or advanced practice registered nurse. I understand that no guarantees have been made regarding the outcomes of this care.

I consent to provide breath, blood, hair, or urine samples for alcohol and/or drug testing, and I authorize these samples to be sent to a laboratory for analysis if necessary. I understand that refusal to submit to testing may result in consequences with my employer, potential employer, or applicable government agencies.

I acknowledge that I may receive services from physicians or healthcare providers who are not employees of Occupational Medicine Physicians, such as radiologists. I agree that Occupational Medicine Physicians is not responsible for the actions of these non-employees.

I authorize Occupational Medicine Physicians and my treating provider to disclose information regarding my treatment or test results to my employer, potential employer, or insurance carrier as appropriate. I acknowledge that I have received a copy of the Privacy Practices notice.

Telehealth Consent
I understand that telehealth allows me to consult with healthcare providers remotely via electronic communication. I have the right to decline telehealth services and request an in-office visit. My provider may determine that an in-office visit is necessary for appropriate care. I agree that telehealth may be used when mutually agreed upon by me and my provider. I may discontinue telehealth at any time, including during a telehealth visit, and request an in-office visit if preferred.