I hereby agree to the terms of the Information Sheet and Informed Consent Form

INFORMATION SHEET AND INFORMED CONSENT FORM

 

 

SERVICE PROVIDER

 

Commercial Title: İstanbul Memorial Sağlık Yatırımları A.Ş.

Central Reg. no: 0614051604300011

Address: Burhaniye Mah, Nagehan Sokağı No:4/A D:1, 34676 Üsküdar/İstanbul

Phone: 0212 314 66 66

E-mail:info@memorial.com.tr

 

 

 

1.       DESCRIPTION AND SCOPE OF SERVICE

 

Description of Service: Online Doctor Consultation Service

 

The scope and terms of the Service consist of online doctor consultation services provided under the Agreement. This service is not an alternative to a direct physical examination or treatment as the service and information that we provide will be limited to the documents and information that you will submit during the online visit. You cannot receive diagnosis or prescription with online service. Please note that the medical opinion and service that you will be provided online will neither be of binding nature nor substitute a direct physical examination. As the medical opinions to be provided by our doctors are solely advisory, you are kindly informed that you should assess such medical opinions with your doctor or our attending doctors.

This service excludes any situation that requires emergency response within the first 24 hours after any sudden disease, accident, injury, cranial or spinal injury, trauma, loss of consciousness, severe burn, chest pain, vomiting or similar situation. Patients with the mentioned symptoms are advised to refer to relevant Emergency Service Units immediately.

The services and information that we provide in the scope of Visual Online Doctor Consultation Service are not an alternative to a direct treatment or examination as they will be limited to the documents and information that you will submit during the online doctor consultation service. You cannot receive diagnosis or prescription with online service. Please note that the medical opinions that you will be provided in the scope of the online consultation service will neither be of binding nature nor substitute a direct physical examination. As the medical opinions to be provided by our doctors are solely advisory, you should assess such medical opinions with your doctor or our attending doctors.

We would like to remind you that you cannot receive physical examination, diagnosis or prescription during the Online Doctor Consultation Service. The Online Doctor Consultation Service is in no way a substitute for conventional medicine but solely of advisory nature; you are recommended to refer to your doctor to assess the information that you will receive using our online doctor consultation service.

You are hereby informed that it will be under your own responsibility to provide the Online Chat Applications (Facetime, Whatsapp, Skype, Google Hangout Meet, etc.) and the internet connection speed (minimum 8 Mbps) required, the details of which will be indicated during appointment for the service.

We acknowledge that you will submit only such information and documents that belong to you as the user of our Online Doctor Consultation Service. You are hereby informed that, in case it is found out that you have submitted any information or document that belong to third parties, you will be held liable for any violation of rights under relevant laws, including privacy breach.

Although the documents that you will submit will be processed in confidentiality by our hospital, you are deemed to have acknowledged that such documents may be disclosed to other relevant doctors or medical staff to assess the symptoms described by you, and you will not be entitled to claim any rights due to such disclosure of information.

Our hospital will not be liable for any technical problem of violation of rights that may arise out of any intermediate application / software/ service used to submit your medical files to attending doctors of our hospital.

Unless you have declared otherwise to the relevant institution or to the intermediate application, device or tool that you use for access to the Online Doctor Consultation Service, you are deemed to have granted your consent to the use and retention of your contact information by affiliates to our hospital for purposes of notification, advertisement and announcement.

Although the documents that you will submit will be processed in confidentiality by our hospital, you are deemed to have granted your prior consent to the disclosure of your documents by other doctors or medical staff and companies of the group.

Our Hospital will not be liable for data security, retention or disclosure in respect of your documents and information that you will submit online. You will not be entitled to claim any rights for any loss of data, privacy breach or disclosure which may arise out of your disclosure of data on the web without the knowledge of our hospital.

Date of Service: It refers to the most suitable date and time to be scheduled at the Service Recipient's option and upon mutual agreement with the relevant doctor from any branch chosen by the Recipient, depending on the availability of the doctor.

Duration of Service: 10 minutes.

 

 Provision of Service: In order to receive the provided service, the Service Recipient agrees to install an Online Chat Application (Facetime, Whatsapp, Skype, Google Hangout Meet, etc.), the details of which will be described by the Service Provider during the appointment stage, on his/her personal computer/ smartphone, etc. and to create an account to be able to use the relevant application.

 

 

The Service Recipient is liable to provide minimum internet speed of 8 Mbps in order to ensure uninterrupted and effective online service.

The Service Provider will not be held liable for any partial and/or total failure in the online conversation due to lower visual quality or internet speed than specified in the Agreement.

Service Rates: The fee for the service varies depending on the location and academic title of the doctor chosen for the service; the rates listed below will be applicable: The amounts indicated in the table are inclusive of VAT.

 

Online Doctor Consultation Service Rates

 

İstanbul (Şişli, Bahçelievler, Ataşehir Hospitals)

Attending Doctor: TRY 200

Associate Professor : TRY 350

Professor: TRY 400

 

 

Hizmet Hospital

Attending Doctor: TRY 125

Associate Professor : TRY 175

Professor: TRY 225

 

 

Wellness

Associate Prof: TRY 1.250

 

Ankara

Attending Doctor: TRY 150

Associate Professor : TRY 200

Professor : TRY 250

 

 

Medstar Antalya and Kayseri Hospitals

Attending Doctor: TRY 100

Associate Professor : TRY 150

Professor : TRY 200

 

 

Diyarbakır

Attending Doctor: TRY 75

Associate Professor : TRY 100

Professor : TRY 150

 

 

Rates per Online Session with the Psychologist / Psychiatrist

 

Şişli

Clinical Psychologist: TRY 315

Attending Psychiatrist: TRY 495 / Attending Pediatric Psychologist: TRY 440

Professor of Psychiatry: TRY 540

Assoc. Prof. of Pediatric Psychiatry : TRY 540

 

 

Ataşehir

Clinical Psychologist: TRY 430

Attending Psychiatrist: TRY 540

Attending Pediatric Psychiatrist : TRY 540

Professor of Psychiatry: TRY 620

 

 

Bahçelievler

Clinical Psychologist: TRY 360

Attending Psychiatrist: TRY 570

 

 

Hizmet Hospital

Clinical Psychologist: TRY 155

Attending Psychiatrist: TRY 270

 

 

Ankara

Clinical Psychologist: TRY 315

Attending Psychiatrist: TRY 420

 

 

Medstar Antalya

Clinical Psychologist: TRY 170

Attending Psychiatrist: TRY 200

 

 

Kayseri

Clinical Psychologist: TRY 90

Attending Psychiatrist: TRY 200

 

 

Rates per Session with Online Nutritionist and Dietitian

 

 Wellness

 

First Session: TRY 450

Nutrition and Diet Session: TRY 325

 

The rates are applicable for Vildan Çelik and the duration of session is 45 minutes.

Payment Mode and Schedule: Fees will be paid by credit card in a single amount, using online virtual POS application.

Billing address: Following the provision of service, an e-invoice will be made out and sent to the Service Recipient's e-mail address indicated above.

 

 RIGHT OF WITHDRAWAL

The Service Provider undertakes that the Service Receiver possesses the right of withdrawal from the service from the signing of the agreement until the date of provision of service, without assuming any legal or penal liability or indicating any reason whatsoever. Notices regarding the right of withdrawal or any other communication related to the agreement may be sent to the Service Provider's contact address indicated in article 1 above.

The Service Recipient can use his/her right of withdrawal only on the condition that he/she will duly notify the Service Provider in conformity with terms of the relevant law during the mentioned period.

For cancellations notified until no later than 2 hours prior to the appointment, the service fee will be cancelled without any price charged. However, as for services cancelled within any period less than 2 hours prior to the appointment, 30% of the service fee will be collected and the remaining amount will be refunded.

 

COMPLAINT HANDLING AND DISPUTE SETTLEMENT

The Service Recipient may call 444 7 888 or contact via the link https://www.memorial.com.tr/iletisim to report any problems, feedbacks or complaints regarding the provided service.

In case of any disputes which may arise out of this Agreement, the parties will refer to the Provincial or District Arbitration Committee for Consumer Problems in the Recipient's place of residence or in the location where the service has been purchased for any amounts up to the value announced on annual basis by the Ministry of Customs and Trade, and to Consumer Courts for any amounts over the mentioned value.

The information specified above is an integral part of the remote service agreement; no amendment may be made to the information herein unless otherwise is agreed upon by the parties.

I hereby declare, agree and undertake that I attend the Online Doctor Consultation Service within my own knowledge and I acknowledge and agree to the terms above as well as possible risks which will not be limited to those described hereinabove.

 

SERVICE RECIPIENT                                        SERVICE PROVIDER