Second Opinion Physician

Telemedicine Disclosure Agreement


Second Opinion Physician Telemedicine

Second Opinion Physician focuses on depression, behavioral disorders, and overall mental health.

Our medical director, David Epstein, D.O., is a licensed integrative and functional osteopathic physician.

Second Opinion Physician Telemedicine Disclosure Statement:

Dr David Epstein, D.O. is the sole practitioner and owner, and operator of all activities at Second Opinion Physician, P.C.

II. Methods of Telemedicine: Second Opinion Physician uses various modes to communicate and evaluate, including:

  • Patient medical records
  • Secure email for private information sharing and transfer of documents.
  • Real-time video and or audio interactions
  • Relevant patient evaluation documents provided with Biotype Assessments.
  • Online HIPPA compliant-secure, questionnaire and consent forms.

III. Security Measures: To safeguard your information:

  • Second Opinion Physician adheres to protocols ensuring the confidentiality and integrity of patient data.
  • Our email and EMR system are HIPAA compliant.
  • Our website server is robustly secure, but not HIPAA certified. Therefore, please avoid sharing sensitive data via chat or website contact forms.

IV. Benefits: With Second Opinion Physician, you receive:

  • Options for testing and or consultations and both.
  • Consultation from Dr. David Epstein, D.O., a licensed Osteopathic General Practice physician with extensive experience in Functional Medicine.
  • Coordination of lab test ordering, querying relevant issues when making an assessment, this includes results and questionnaire review.
  • Extensive follow up phone call (15-30 minutes) with Dr Epstein, included with the Biotype Assessment.
  • A focus on the Walsh Approach, targeting mood and behavioral disorders through supplements, lifestyle changes, and diet.
  • Strategy to improve imbalances related to methylation, copper/zinc ratios, pyroluria, and toxic overload and digestive health.
  • Follow up reassessments, possible including unrelated conditions.  However, for medication-related queries, patients are asked to consult with their own, local, prescribing physician or primary care provider. Dr Epstein may suggest and ideally suited local practitioners or make a formal referral to an appropriate practitioner.
  • A completely non-pharmaceutical approach with a focus on addressing conditions like depression, anxiety, autism, and dementia, etc.
  • Simple ordering of lab tests online and relaying requisition directly to patients for local lab testing.
  • Ongoing access to labs and reports for quick resend if necessary.
  • Fast turnaround for all testing, evaluations and correspondences.

V. Potential Risks: Like any medical procedure, there are inherent risks to working with a telemedicine physician:

  • Inability to physically assess the patient, face to face, visit may present some risk, should the condition be more serious than recognizable.
  • Digital data is always vulnerable to outside forces.
  • Dependent on internet access. If there is an extended outage between our computers, secure data servers, labs and patients, access may be limited.
  • We do not address issues that require attention to or discontinuation of medications.

VI. Consent Provisions: Your rights and obligations include:

  • Abiding by standard medical privacy regulations.
  • Freely withdrawing or withholding consent at any juncture.
  • Accessing and obtaining telemedicine records.
  • Exploring alternative medical care avenues.
  • Being aware that patient data might be shared with other medical professionals.
  • Responsibility to report other electronic health consultations.
  • Understanding that results aren't guaranteed.

VII. Acknowledgement: By signing below, I confirm that I've read, understood, and clarified any concerns about the provided information. I consent to telemedicine consultation under Second Opinion Physician.


Patient Signature: ________________________________________ Date: _______________