I, ______________________________, agree to indemnify, defend, protect, and hold harmless the medical providers employed by Medivive Telehealth Services; and their respective officers, directors, employees, stockholders, assigns, successors, and affiliates (Indemnified Parties) from, against, and in respect of all liabilities, losses, claims, damages, judgments, settlement payments, deficiencies, penalties, fines, interest, and costs/expenses suffered, sustained, incurred, or paid by the Indemnified Parties in connection with or arising out of, directly or indirectly:
The medical providers employed by Medivive Telehealth Services rendering medical care, services, advice, and/or treatment.
I am aware of the potential side effects associated with the therapies offered, and I accept all risks involved with IV infusions, hormone replacement therapy, and injectable therapies. I will not seek indemnification or damages from the Indemnified Parties.
Printed Name: _________________________________
Signature: _________________________________
Date: ___________________
Witness: _________________________________
Date: ___________________
“Our telehealth services are designed to provide convenient, remote healthcare, but certain conditions may require in-person care. Our providers will refer you to a trusted local provider if your needs extend beyond telehealth.”
© Copyright 2024 Medivive Telehealth Services | Made By DigiGrows LLC
