Informed Consent to Care
Last updated: July 23, 2026
General Consent to Treatment
By receiving services at Ebenezer Health Clinic — in person or via telehealth — you consent to evaluation and treatment by our provider(s).
Telehealth Consent
- Telehealth uses secure video to deliver care remotely. Benefits include convenience and access; limitations include the inability to perform a physical exam and situations where in-person care is necessary.
- You must be physically located in Oklahoma at the time of a telehealth visit.
- If the provider determines telehealth is not appropriate for your needs, you may be directed to in-person or emergency care.
- Technology may fail; alternative arrangements will be made if a visit is interrupted.
[ATTORNEY: add Oklahoma-mandated telehealth consent elements and patient acknowledgment.]
In-Person / Walk-In Care
In-person visits occur at our Oklahoma City clinic. Walk-in availability depends on clinic capacity.
Injections & IV Therapy Consent
- These services are provided after a provider evaluation and are supportive wellness services, not a treatment or cure for any medical condition.
- Possible risks include (without limitation) discomfort, bruising, infection at the injection/IV site, or allergic reaction.
- These services are not appropriate for medical emergencies.
[ATTORNEY/CLIENT: complete risk disclosures per service; consider a separate signed consent form for IV therapy.]
No Guarantee of Outcomes
No specific result is promised. Individual results vary.
Financial Consent
You understand services are cash-pay and agree to the fees presented before service. Medication, when prescribed, may be billed separately.
Acknowledgment
By proceeding, you acknowledge you have read and understood this consent.
[ATTORNEY: add signature/e-consent capture mechanism and record keeping.]