Consent to Treatment

Last updated: August 1, 2024

I authorize the medical staff, other personnel, and such associates, assistants, and other healthcare providers of Kind Health Medical Group Inc. (“Kind Health”) to provide care, including telehealth or other services, as Kind Health Medical Group Inc.'s staff finds necessary or advisable in my care. If I am making this authorization on behalf of another person, I acknowledge that I am consenting on behalf of the patient and am authorized to do so.

Consent to Health Records Requests

I authorize the medical staff, other personnel, and such associates, assistants, and other healthcare providers of Kind Health to request, receive, and use my medical records as Kind Health's staff finds necessary or advisable in my care. If I am making this authorization on behalf of another person, I acknowledge that I am consenting on behalf of the patient and am authorized to do so.

Digital Copy

I agree that a digital copy of this agreement shall be valid as the original.