Enter 000, if you do not have a health card number.
I give consent and permission for Dr. Lai and his associates to communicate and exchange my personal and medical information with other members of my healthcare team for the purposes of managing my health. I understand that the electronic medical record at GWC is a common shared system among the associates of the clinic. I understand that only those health care providers who have an active role in treating me are considered part of my circle of care; and that they may have access to my records but limited to what is necessary in order to provide me with the care they are responsible for.
I give express consent to Spring Health Corp, Get Well Clinic, Get Well Rehab, Dr. Lai and Associates, to communicate with me via electronic communications for purposes including, but not limited to: general advice, specific coaching, receiving reminders, announcements, and promotions for features, products, services, or other allied-health providers relating to my healthcare. I understand that electronic communication is not a substitute for in-person communication or clinical examinations with a doctor, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required). I understand that I can unsubscribe from such communications at any time in writing. I understand that any communications through paper, phone, fax, email, text, or video-conferencing has inherent security and privacy risks. I endeavor to engage in safe communication practices. I understand that Get Well Clinic cannot guarantee confidentiality when communicating with insecure methods (such as email). I hereby covenant and agree to release, indemnify, and save harmless Spring Health Corp, Get Well Clinic, Get Well Rehab, Associates and staff for any costs, losses, damages, liabilities, claims, actions, proceedings and all legal and other costs of any action whatsoever, from what may occur as a result of communicating through paper or electronic methods.