Informed Consent Agreement

Last revision: April 3, 2020

Description of Services

The Healthcare Professionals at Alamo Heights Implant Center provide healthcare services using interactive audio and video technologies where you and the Healthcare Professional are not in the same physical location. You can form an ongoing treatment relationship with a Healthcare Professional, however, your initial visit may begin as a consultation (e.g. to determine the most appropriate treatment setting for you to receive care) and will not necessarily give rise to an ongoing treatment relationship. You should seek emergency help or follow-up care when recommended by a Healthcare Professional or when otherwise needed, and continue to consult with your other healthcare providers as recommended. Among the benefits of our Services are improved access to healthcare and convenience. However, as with any health service, there are potential risks associated with the use of technology.

These risks include, but may not be limited to:

  • In rare cases, information transmitted may be insufficient for healthcare decision making.
  • Disruptions can occur due to failures of the electronic equipment or internet connection. If this happens, you may be contacted by phone or other means of communication.
  • In rare cases, a lack of access to all of your health records may result in adverse drug interactions or other errors.
  • Although we incorporate strong security protocols to protect the confidentiality of your health information, in rare instances security protocols can fail, causing a breach of confidentiality.

By accepting this consent you acknowledge that you understand and agree with the following:

  • We may share information about the health care services you receive from us with your health insurance company. This may include information relating to genetic testing, substance abuse, mental health, communicable diseases and other health conditions, subject to the terms in our Privacy Policy.
  • If your health insurance coverage does not pay for your Services charges in full, you may be fully or partially responsible for payment.
  • Our Health Professionals may share your health records with other health care providers for purposes relating to the provision, coordination or management of your healthcare so that we can meet your healthcare needs. This may include information relating to genetic tests, substance abuse, mental health, communicable diseases and other health conditions, subject to the terms in the Alamo Heights Implant Center Privacy Policy.
  • We may determine that our clinical services are not appropriate for some or all of your treatment needs and may elect not to provide clinical services to you through the Site.
  • With respect to psychotherapy, you are entitled to receive information from your Healthcare Professional about the methods of therapy, the techniques used, the duration of your therapy (if known), and the fee structure. You can seek a second opinion from another therapist or terminate therapy at any time.
  • You attest that you have legal authority to act as guardian or personal representative of all children registered under your Account.
  • No results can be guaranteed or assured.


Emails or electronic messages to Alamo Heights Implant Center or any of our Healthcare Professionals may not be returned immediately. If you are experiencing a medical emergency, you should call 911 or go to the nearest emergency room.