For Patients Booking Teledoc Appointments via Hometown Pharmacy
Please read this consent carefully before proceeding with your telehealth appointment. By continuing, you acknowledge that you understand and agree to the following terms.
Telehealth (also called telemedicine) allows you to consult with a licensed healthcare provider remotely through secure video, phone, or digital communication. This service is offered for your convenience and accessibility through Hometown Pharmacy’s trusted Teledoc platform.
During your telehealth visit, your provider will:
Ask questions about your symptoms, history, or concerns
Provide medical advice, diagnosis, and treatment where appropriate
Prescribe medication or request further testing if needed
Communicate with your pharmacist if follow-up or coordination is required
You have the right to:
Receive the same quality of care as you would in-person
Refuse or withdraw from telehealth services at any time without affecting your right to future care
Ask questions and receive answers about the technology, risks, and alternatives
Request a copy of your telehealth visit records or notes
Know the names and credentials of anyone involved in your care
While telehealth is generally safe and effective, there are potential risks, including:
Technology failure or disconnection
Possible delays in care due to missing information
Reduced physical examination ability compared to in-person visits
Rare risk of unauthorized access to data, despite best security practices
We use secure, HIPAA-compliant platforms to protect your health information and privacy.
Depending on your insurance plan, your telehealth visit may be:
Fully covered
Subject to a copay or fee
Not covered (in which case you may be responsible for out-of-pocket payment)
Our team will provide cost transparency before your visit, and you’re welcome to ask about pricing or payment options.
By continuing, you agree to:
Provide accurate and honest information about your health
Ensure a safe, private space for your telehealth appointment
Be available and responsive at the scheduled time
Contact 911 or your nearest emergency facility if you experience a medical emergency
Telehealth visits are not intended for life-threatening or emergency conditions.
By submitting this form or booking a telehealth appointment through Hometown Pharmacy, you confirm that:
✔️ You understand what telehealth is and agree to receive care through this method
✔️ You understand the risks, benefits, and limitations involved
✔️ You give permission for your health information to be shared securely between your provider and Hometown Pharmacy, if necessary for treatment
✔️ You have had the opportunity to ask questions about this consent form and telehealth services
📍 Hometown Pharmacy
450077 State Road 200, Unit 4
Callahan, FL 32011
📞 (904) 515‑0929
📧 info@thehometownrx.com
If you have any questions or concerns before your appointment, please don’t hesitate to reach out.