Patient
Patient Consent
By submitting this form, I confirm that the information I provide is accurate to the best of my knowledge, and I consent to Novacare Access collecting and using my personal and healthcare-related information for the purpose of responding to my inquiry and helping coordinate my healthcare journey.
I understand that Novacare Access may share relevant information with selected healthcare providers, clinics, hospitals, and healthcare professionals when necessary to identify suitable care options, obtain medical opinions, arrange consultations, or coordinate my requested healthcare services.
I understand that:
My information will be used only for purposes related to my healthcare inquiry and coordination of services.
My medical information may be shared with relevant healthcare providers when necessary to support my request.
Healthcare providers are independently responsible for the diagnosis, treatment, medical advice, prescriptions, and clinical care they provide.
I may choose not to provide optional information; however, this may limit Novacare Access’s ability to assist with my request.
I can contact Novacare Access regarding my personal information or withdraw my consent, subject to applicable legal and regulatory requirements and any services already provided.
Required Consent
I have read and agree to the Patient Consent & Data Use Approval above, and I authorize Novacare Access to use and share my information as described for the purpose of providing healthcare access and journey coordination services.
Optional Marketing Consent
I agree to receive relevant healthcare updates, offers, and information from Novacare Access by WhatsApp, SMS, email, or other communication channels. I understand that I can withdraw this consent at any time.
Medical Documents
I authorize Novacare Access to share the medical documents and information I provide with relevant healthcare providers for the purpose of reviewing my case and coordinating my requested healthcare services.