TELEHEALTH SERVICES
Effective Date: 4/6/2026
Prime Form Care, LLC (“Prime Form Care,” “we,” “our,” or “us”) provides medical services through secure telehealth technology.
Services are provided by:
Viridiana Fuentes Rosales, FNP-C
Founder & Clinical Director
What Is Telehealth
Telehealth allows patients to receive medical care remotely using electronic communication, including:
- Video consultations
- Telephone consultations
- Secure messaging
- Electronic prescribing
This approach enables evaluation, diagnosis, and treatment without an in-person visit when clinically appropriate.
Benefits of Telehealth
- Increased access to care
- Convenience and time savings
- Reduced travel and wait times
- Ongoing monitoring and follow-up
Limitations of Telehealth
- Telehealth may not be appropriate for all conditions
- Some medical concerns may require in-person evaluation
- Physical examination is limited compared to in-person care
Patient Location Requirement
Telehealth services are only available to patients who are physically located in a state where the provider is licensed at the time of the visit.
Technology & Security
Prime Form Care uses secure systems designed to protect patient information. However, no electronic system is completely secure, and there is a potential risk of unauthorized access despite reasonable safeguards. Telehealth services are subject to our Privacy Policy and Notice of Privacy Practices.
Patients are encouraged to:
- Use a secure internet connection
- Participate in visits from a private setting
Technical Issues
In the event of technical difficulties, appointments may:
- Continue via telephone, or
- Be rescheduled as needed
Not for Emergencies
Telehealth services are not intended for emergency medical care.
If you are experiencing a medical emergency:
- Call 911
- Go to the nearest emergency room
Prescribing & Treatment
Medical decisions, including prescribing, are based on clinical judgment and medical necessity.
- Not all conditions are appropriate for telehealth treatment
- Prescriptions are not guaranteed and will only be issued when clinically appropriate and permitted by law.
- Certain medications, including controlled substances, may be subject to additional federal and state regulations.
Communication
Prime Form Care may communicate with patients through:
- Phone
- Secure messaging
- SMS/text messaging (if opted in; message and data rates may apply, and you may opt out at any time)
Next Steps
A provider–patient relationship is established only after completion of intake, clinical review, and acceptance into care.
Before receiving care, patients are required to:
- Complete intake forms
- Review and sign telehealth consent
- Be formally accepted as a patient
Consent to Telehealth Services
By proceeding with telehealth services, you acknowledge that you have read and understand this information and agree to receive care via telemedicine.
Participation in telehealth services is voluntary, and you may withdraw consent at any time prior to or during a visit.