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Telemedicine Services Agreement

A completed remote healthcare service agreement covering consultations, identity, prescribing limits, privacy, fees, emergencies and clinical independence.

Jurisdiction: England and Wales - completed fictional worked example

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An editable Microsoft Word version is available from the interactive page.

Important: This sample provides general legal information only and is not legal advice. Check the law, prescribed forms and signing requirements that apply to your exact jurisdiction and circumstances before use.

# TELEMEDICINE SERVICES AGREEMENT

Date: 5 November 2029

Parties: Harbour Health Online Limited and Benjamin Clarke

## 1. Parties and purpose

Harbour Health Online Limited (Company No. 11908741), 9 Riverside Exchange, London SE1 2AQ, provides Benjamin Clarke of 31 Oakfield Road, London SE14 5QJ with remote GP consultations through its secure platform. The service is private healthcare and does not replace NHS access or emergency services.

## 2. Scope, price and subject

A standard video consultation costs £65 including VAT and lasts up to 20 minutes; a follow-up within 14 days costs £40. Benjamin pays by card before booking. A clinician may decide that a physical examination, face-to-face referral or no treatment is clinically appropriate; payment does not guarantee a prescription, diagnosis or particular outcome.

## 3. Operating duties

Benjamin must give his real name, date of birth, address, current location at consultation, medication, allergies and relevant history. The clinician verifies identity, records clinical notes and may prescribe only where lawful and clinically safe. Controlled drugs, certain high-risk medicines and work or driving certificates may require an in-person route.

## 4. Rights, records and compliance

Harbour processes health data under UK GDPR and the Data Protection Act 2018 with appropriate confidentiality and security. Records are retained for the applicable NHS and professional period; Benjamin can exercise data rights subject to clinical-record exemptions. The platform may be unavailable and is not to be used for urgent symptoms.

## 5. Term, ending and remedies

If Benjamin reports chest pain, severe breathing difficulty, stroke symptoms, immediate self-harm risk or another emergency, Harbour directs him to 999, A&E or NHS 111 as appropriate. Clinicians remain independent and Harbour does not promise a preferred clinical decision. Complaints may be made to Harbour and relevant professional or regulatory routes.

## 6. Liability and reservations

Benjamin may cancel without charge more than 24 hours before an appointment; a late cancellation or non-attendance is charged £25 unless illness or exceptional circumstances make that unfair. Harbour may suspend an account for abuse, fraud or unsafe use, but statutory patient rights and continuity information are preserved.

## 7. Governing law and signatures

England and Wales law governs and its courts have jurisdiction. Benjamin and Harbour's clinical director Dr Ruth Allen sign on 5 November 2029. Nothing excludes liability for negligent clinical care, death, personal injury, fraud or rights that cannot legally be excluded, and this agreement is not medical advice itself.

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