This consent form is provided to ensure that you, as the patient, understand and agree to the handling of your personal and medical information, as well as the risks associated with online medical consultations through MedConnect (hereinafter referred to as “the Service”).

1. Consent for Handling of Personal Information

I confirm and agree to the following:

• The Service will collect and use my personal information, such as name, address, contact details, nationality, date of birth, health information, symptoms, and diagnosis, for the purpose of providing medical consultations and diagnosis.
• The consultation will be video recorded for the purposes of improving service quality and preparing medical documentation.
• The Service will not provide my personal information to third parties without my prior consent, except where required by law.
• My personal information will be stored securely as part of my medical records for an appropriate period of time.
• I have the right to request access, correction, or deletion of my personal information held by the Service.

Consent for Online Medical Consultations

I understand and agree to the following risks and limitations associated with online medical consultations:

• Online consultations may have limitations in diagnostic accuracy due to the inability to perform a direct physical examination.
• There may be technical issues (e.g., communication disruptions, problems with video or audio) that could interrupt the consultation.
• Online consultations may not be suitable for medical emergencies, and in such cases, I may need to seek in-person care or emergency medical services.
• I am responsible for ensuring that I have the necessary devices and internet connection to participate in the online consultation.
• This service differs from actual online medical consultation; therefore, we are unable to issue prescriptions or medical certificates. However, upon request, we can provide a medical record or a referral letter in either Japanese or English.

Consent for Data Protection

understand and agree that the Service will take appropriate technical and organizational measures to protect my personal information, as follows:

• The Service will use measures such as SSL encryption to prevent unauthorized access or leakage of my personal information.
• In the event of a personal data breach, the Service will promptly take appropriate action and notify me of the incident.

4. Consent for Data Protection

I understand and agree that the Service will take appropriate technical and organizational measures to protect my personal information, as follows:

• The Service will use measures such as SSL encryption to prevent unauthorized access or leakage of my personal information.
• In the event of a personal data breach, the Service will promptly take appropriate action and notify me of the incident.

5. Validity of This Consent Form

This consent form becomes valid at the time the online medical consultation appointment is completed.