Consent Form
RELEASE & WAIVER OF LIABILITY FORM
On behalf of SalusWell, we would like to say how pleased we are that you have chosen
to join us. We are dependent on the contributions of our health professionals and thank
you for supporting us in our efforts to promote and serve online (telehealth) services to
the consumers by providing Lifestyle Health and Wellness Counselling for healthier and
happier life.
Please review our Terms and Conditions of this Agreement and Liability Release Form, so that you are
fully aware and agree on the obligations and responsibilities of your service as an independent
service provider with SalusWell.
SalusWell reserves the right to change its terms and conditions from time to time. If, and when, we
make any changes, we will advice you accordingly. We want this service experience to be rewarding,
enjoyable and productive for you and everyone involved in this collaborative effort to serve
consumers with your help manage their health challenges for healthier and happier life. We are
confident that you will find your fellow health professionals to be special, highly valued group of
individuals whose commitment to SalusWell will be integral to this incredible Telehealth Service for
much needed Lifestyle Health and Wellness.
- Service Participation: I, the Health Professional, acknowledge that I am credentialed Health Professional and, I am registering to be an Independent Telehealth Practitioner on the SalusWell Lifestyle Health and Wellness Telehealth Portal.
- Waiver and Release: I, the Health Professional, release and forever discharge and hold harmless SalusWell and its successors from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide on the SalusWell Telehealth Portal. I understand and acknowledge that this Release discharges SalusWell from any Liability or Claim that I may have against SalusWell with respect to my conduct, behavior, or damages that may result from the services I provide to consumers or occurring while I am interacting with other Health Professionals while utilising the SalusWell Telehealth Portal to provide my professional services.
- Insurance: I understand that SalusWell does not assume any, responsibility for, or obligation to provide me with insurance or other assistance, including financial or other benefits. I expressly waive any such claims for compensation or liability on the part of SalusWell. I further understand as a Care Provider, that I am always fully responsible for always maintaining my own Personal Professional Liability Insurance while I am providing my professional services on SalusWell Telehealth Portal.
- Assumption of Risk: I am aware that there may be various risks in participating in providing Telehealth Services while on SalusWell Telehealth Portal including, but not limited to verbal abuse, harassment of any kind, theft of data, emotional injuries however arising, and/or unforeseen catastrophic events (Risks). Notwithstanding these risks, I understand that I am participating as a Health Professional Service Provider with SalusWell with this full knowledge of this risks involved and agree to accept any and all risks as listed. If you have any concerns about agreeing to this assumption of risks, we will ask that you please decline from providing your service as SalusWell Telehealth Professional.
- Professional Interaction With Others: During my Health Professional Services to SalusWell, I agree to abide by all SalusWell policies set out herein and generally conduct myself with professionalism, courtesy and respect for others. I agree to take responsibility for my actions and for how those actions might affect others. I agree to avoid undertaking any behavior that will disrupt others, harm or negatively impact any service and SalusWell. Prohibited conduct includes but is not limited to any kind of verbal abuse, harassment based on race, gender, sexual orientation, disability or any other protect ed group status as provided by local, state, provincial and/or federal law. For further clarity, this would include yelling or threatening others, sexual harassment of any kind whatsoever, and critical commentary of another person’s views or religious beliefs. In general, we seek to preclude any prohibited conduct which has the purpose or effect of interfering with another person’s ability to enjoy, benefit from participating in SalusWell. Person’s who are target of, or witnesses to hostile or harassing conduct should immediately contact SalusWell Management. SalusWell has a zero-tolerance policy for such behavior which may include but is not limited to expulsion from your service and suspension of your account at SalusWell Telehealth Portal. If you are ever unsure as to whether a behavior or course of conduct is appropriate, you agree that you will speak to the SalusWell Management immediately for direction and guidance.
- Photographic and Material Release: I grant and convey to SalusWell all rights, title and interest to any and all photographic, images, videos and audio recordings of me, my likeness and my voices made by SalusWell and any material I provide to SalusWell in connection with my providing telehealth services and being part of the SalusWell group of Health Professionals.
- Others: As a SalusWell Health Professional, I expressly agree that this Release is intended to be as broad and inclusive as permitted by the laws across the states and provinces and that this Release shall be governed by and interpreted in accordance with the laws of Ontario and Canada. I agree that if any clause or provision of this Release is deemed invalid, the enforceability of the remaining provisions of this Release shall not be affected.
By accepting and agreeing, I express my understanding and intent to enter this Release and Waiver of Liability both willingly and voluntarily.