Consent Agreement

Consent to Treat

‍I authorize the medical staff, other personnel, and such associates, assistants, and other health care providers of Pairtu, Inc. (“Pairtu”) to provide care, including telehealth or other services, as Pairtu, 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 I am authorized to do so.


Consent to Health Records Requests

‍I authorize the medical staff, other personnel, and such associates, assistants, and other health care providers of Pairtu, Inc. to request, receive, and use my medical records as Pairtu, 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 I am authorized to do so.


Digital Copy

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