TERMS & CONDITIONS

HEAL BEIRUT

INDIVIDUAL CONSENT AND RELEASE FORM


 

I acknowledge that any discussions or consultations arranged by Heal Beirut do not constitute medical or healthcare treatment or specific medical or behavioral health advice. I understand that I am not creating a provider-patient relationship with Heal Beirut or any individual or provider (each a “Provider”) with whom I may communicate or be connected to via Heal Beirut and that neither Heal Beirut or any providers with whom I communication will have any responsibility to provide ongoing or follow up care or treatment. I acknowledge that the Provider with whom I may communicate is not licensed to practice medicine, dentistry, or any other professional services, including therapy services, in Lebanon and may not hold a license in the United States. I acknowledge that Heal Beirut does not verify the credentials or licensure of any Providers.  Any information provided to me is for informational purposes only and is not intended to, nor does it, constitute medical advice or a diagnosis. My participation in any discussion facilitated by Heal Beirut is not a substitute for a diagnosis, medical advice, or treatment by a physician, dentist, or other licensed health care provider. 

I assume full and sole responsibility to take any and all appropriate actions ‎with regard to my personal and physical condition, and will seek medical advice, care and treatment from a health care provider in Lebanon when necessary. The responsibility for initiating an examination to diagnose any medical condition and/or to obtain advice and professional treatment is solely mine and not that of Heal Beirut or any individual associated with Heal Beirut. 

I acknowledge that I may be provided with the contact information for an organization located in Lebanon that may be able to assist with my physical or mental condition. This does not constitute a referral. Heal Beirut is not assuming any responsibility for me on an ongoing basis by providing me with such contact information, and is not affiliated with any of the organizations for which it may provide contact information. I understand that it is my sole responsibility to initiate contact with such organization(s). 

I acknowledge that Heal Beirut and the Providers do not maintain medical records and Heal Beirut is not a HIPAA covered entity. I expressly agree to assume all risks as it pertains to data breach and confidentiality when providing any of my personal or sensitive information via FaceTime, WhatsApp, e-mail, text, telephone, or any other modes of communication.

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