[{"reviewer_name":"David Maus","review_text":"\"As we get older we can lose the ability to be mentally and physically sharp. To combat this I've started taking NAD+. I work closely with Blokes to ensure everything I take is right for me.\"","reviewer_image":"https:\/\/blokes.co\/wp-content\/uploads\/2024\/03\/dmaus.jpeg"},{"reviewer_name":"Eric Hinman","review_text":"\"Not only did I see my biomarkers improve, I know I'm taking exactly what my body needs for better performance and better day to day life.\"","reviewer_image":"https:\/\/blokes.co\/wp-content\/uploads\/2024\/03\/erich.jpeg"},{"reviewer_name":"CJ Finley","review_text":"\"For years I suffered behind closed doors even though I thought I was doing all the right things. It wasn't until I started working with Blokes did I start to feel better and improve my my life.\"","reviewer_image":"https:\/\/blokes.co\/wp-content\/uploads\/2024\/03\/CJ-.jpeg"}]
Authorization and Consent to Participate in Telemedicine/Telehealth Consultation
The purpose of this form is to obtain your consent to participate in a telemedicine consultation with a provider.
1) Nature of Telemedicine Consultation: During the telemedicine consultation: a) Details of you and/or your medical history, examinations, and laboratory tests will be discussed with other health professionals through the use of interactive video, audio and telecommunications technology. b) Physical examination of you may take place. c) Nonmedical technical personnel may be present in the telemedicine studio to aid in video transmission. d) Video, audio, and/or digital photo may be recorded during the telemedicine consultation visit.
2) Medical Information and Records. All existing laws regarding your access to medical information and copies of your medical records apply to this telemedicine consultation. Additionally, dissemination of any patient-identifiable images or information from this telemedicine interaction to researchers or other entities shall not occur without your consent, unless authorized under existing confidentiality laws.
3) Confidentiality. Reasonable and appropriate efforts have been made to eliminate any confidentiality risks associated with the telemedicine consultation. All existing confidentiality protections under federal and state law apply to information disclosed during this telemedicine consultation.
4) Risks and Benefits. The benefits of telemedicine include having access to medical specialists and additional medical information and education without having to travel outside of your local health care community. A potential risk of telemedicine is that because of your specific medical condition, or due to technical problems, a face-to-face consultation still may be necessary after the telemedicine appointment. Additionally, in rare circumstances, security protocols could fail causing a breach of patient privacy. The alternative to telemedicine consultation is a face-to-face visit with a physician.
My health care practitioner has discussed with me the information provided above. I have had an opportunity to ask questions about this information and all of my questions have been answered. I understand the written information provided above.
I acknowledge receipt of Blokes Authorization and Consent to Participate in Telemedicine/Telehealth Consultation
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NY & NJ Residents
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Behavioral Health Resources
Thank you for choosing us to provide support with your health needs. We want to ensure our patients receive the most appropriate and evidence-based care when working with our team of medical professionals. Unfortunately, the behavioral health history that you have identified is not considered to be best practice when treated through telehealth. When individuals are experiencing conditions that you have identified, since patient safety is paramount, we refer them to a trusted local provider in their immediate area for in-person care for the most beneficial results.
We apologize for any inconvenience this may cause and fully appreciate the opportunity that you have provided us in choosing our service for your care. We have curated this list of resources to assist based on potential needs and/or concerns that were mentioned during your visit.
Crisis/Emergency Resources:
Phone Call:
988 - Crisis Support Lifeline
1-800-273-8255 - National Crisis Support
1-866-488-7386 or text START to 678678. A national 24-hour, toll free confidential suicide hotline for LGBTQ youth.
Text:
Text MHA to 741741 and you will be connected to a trained Crisis Counselor. Crisis Text Line provides free, text-based support 24/7.
