Agreement B
Telemedicine Terms and Conditions for Patients Governing the purchase and receipt of telemedicine services on the Lakeshore Clinic platform.
Important
This consent is required before every consultation — not just at account creation. It takes approximately 2 minutes to read. The “Start My Consultation” button will not activate until all boxes are checked. Your consent is timestamped and stored with your consultation record.
Who Is Providing Your Care Today Your consultation will be conducted by an independently licensed physician. Below you will see their full name, their provincial medical licence number, and the province in which they are licensed. Lakeshore Clinic Health Technologies Inc. is the technology platform facilitating this connection. Lakeshore Clinic is not your healthcare provider.
Section 1 — Understanding Telemedicine and Its Limitations I understand that telemedicine has limitations compared to in-person care.
The doctor I speak with today cannot physically examine me. They cannot take my vitals, listen to my chest directly, or perform any hands-on tests. I understand that this means they may not be able to fully assess certain conditions, and that in-person care may be recommended.
I understand the doctor may refer me to in-person care if telemedicine is not appropriate.
If the doctor believes that my condition requires a physical examination, diagnostic tests, or emergency intervention, they may advise me to attend a walk-in clinic, specialist, or emergency department. I will follow that guidance.
I understand this platform is NOT for medical emergencies.
If I am experiencing a medical emergency — including chest pain, difficulty breathing, stroke symptoms, severe bleeding, loss of consciousness, or any situation where I believe my life or someone else's life is at risk — I will call 911 or go immediately to the nearest Emergency Department. I will not use this platform for emergencies.
Section 2 — Who Lakeshore Clinic Is and Is Not I understand that Lakeshore Clinic is a technology platform, not my healthcare provider.
Lakeshore Clinic Health Technologies Inc. provides the scheduling, payment, and communication technology for this consultation. My healthcare is being provided by the independently licensed physician named on this screen. Lakeshore Clinic does not practice medicine and is not responsible for the clinical decisions made during my consultation.
I understand the doctor is an independent professional exercising their own clinical judgment.
The physician I consult with today is not an employee of Lakeshore Clinic. They are an independently licensed practitioner who uses the Lakeshore Clinic platform to deliver care. They are solely responsible for the clinical advice, diagnoses, and prescriptions they provide.
I understand that establishing a Lakeshore Clinic account does not create an ongoing doctor-patient relationship.
Each consultation on Lakeshore Clinic establishes a temporary, consultation-specific doctor-patient relationship with the physician named on that consultation. Lakeshore Clinic is not a substitute for having a regular family physician.
Section 3 — The Doctor I Am Seeing Today Before I proceed, I confirm I have reviewed the following information about my consulting physician (displayed on this screen):
I have reviewed the physician's name, licence number, and province of licensure.
This information is displayed above. The physician's licence is registered in the province where I am currently located. If this information is incorrect, I will click “Change Provider” before proceeding.
I confirm I am currently located in the province shown on this screen.
My consultation will be provided under the laws of the province where I am physically located right now. If I am located in a different province from what is shown, I must update my location before proceeding.
Section 5 — Payment, Receipts and Insurance I understand the consultation fee and agree to pay it.
The fee for today's consultation is displayed on this screen. Payment will be processed immediately upon booking confirmation. All fees are in Canadian Dollars (CAD) unless otherwise stated.
I understand that Lakeshore Clinic does not bill my provincial health plan or private insurer directly.
I will be charged the full consultation fee. A detailed, itemised receipt will be generated automatically after my consultation, which I can use to submit a reimbursement claim to my provincial plan (where applicable) or private insurer.
I understand the refund policy.
If a consultation is cancelled by the physician or due to a platform failure before it begins, I will receive a full refund within 5 business days. Consultations that have commenced are non-refundable. If I am dissatisfied with my care, I may contact Lakeshore Clinic support.
Section 6 — Prescriptions I understand that a prescription is at the sole discretion of my consulting physician.
Using Lakeshore Clinic does not guarantee that I will receive a prescription. My physician will prescribe only when clinically appropriate, based on their independent professional judgment.
I authorise Lakeshore Clinic to transmit any prescription to my chosen pharmacy.
If my physician issues a prescription during this consultation, I authorise Lakeshore Clinic to electronically transmit it to the pharmacy I have selected, or to the nearest participating pharmacy if I have not specified a preference. I understand I may be required to produce valid identification at the pharmacy to collect my medication.
Section 7 — My Privacy and Health Information I consent to the collection and use of my personal health information for this consultation.
Lakeshore Clinic will collect, store, and use my personal health information — including the symptom information I have provided, my consultation note, and any prescriptions issued — for the purposes of providing this consultation, generating my receipt, routing my prescription, and complying with applicable health record laws.
I understand my health information is stored securely in Canada.
All my personal health information is stored on Canadian servers using AES-256 encryption, in compliance with the Personal Health Information Protection Act (Ontario), PIPEDA, and applicable provincial privacy legislation.
I understand that my consultation record is accessible to my consulting physician.
My physician will have access to the health information I provided during intake. My records from previous Lakeshore Clinic consultations may also be accessible to physicians I consult on the platform in the future, to support continuity of care.
I understand my consultation may be recorded for quality assurance purposes.
Subject to applicable law, my consultation may be recorded. Recordings are stored securely and are accessible only to authorised Lakeshore Clinic personnel and regulatory bodies as required by law. They are not shared with third parties for commercial purposes.
I understand my rights regarding my health information.
I have the right to request access to, correction of, or deletion of my personal health information held by Lakeshore Clinic, subject to applicable law. I may exercise these rights by contacting privacy@thelakeshoreclinic.com.
Section 8 — My Responsibility as a Patient I will provide accurate and complete information during this consultation.
I understand that the quality of the clinical advice I receive depends on the accuracy of what I tell my physician. I will not withhold or misrepresent my symptoms, medical history, current medications, or any other relevant information.
I understand that it is my responsibility to follow up on my care.
If I receive a referral or recommendation for further testing or in-person care, it is my responsibility to act on it. Lakeshore Clinic and my consulting physician are not responsible for outcomes resulting from my failure to follow up on medical recommendations.
I am at least 18 years of age, or I am the legal guardian of the patient being registered.
If I am creating this account for a minor, I confirm I am their legal parent or guardian and am providing consent on their behalf.
Final Confirmation — Patient I confirm that I have read and understood all sections of this Telemedicine Terms and Conditions. I consent to the consultation proceeding on the terms described above. I understand that Lakeshore Clinic is a technology platform, not my healthcare provider. I understand the limitations of telemedicine. I know to call 911 in an emergency. I authorise the use of my health information as described. I agree to pay the consultation fee shown.
i accept ill write Actual Patient Full Name in the Form
i accept ill write Actual Date of Birth
i accept ill write Actual Province of Location
Your consent is recorded with this consultation. A copy of this consent form, your consultation note, and your itemised receipt will be sent to the email address registered on your account within 15 minutes of the consultation ending.
Lakeshore Clinic Lakeshore Medical & Wellness Clinic, Address: 19044 PR 231 Gimli, Manitoba R0C 1B0, Canada