Effective date: Preparation only — effective date will be completed at actual general-patient release: [Actual general-patient launch date; completed at release]
Purpose and limits
I request a live-video telemedicine evaluation from Luma Wellness Clinic, operated by Luma Wellness, LLC. Telemedicine uses remote communication rather than an in-person examination. The clinician may not be able to assess everything needed remotely and may recommend an in-person visit, testing, urgent care or emergency evaluation. Completing intake or paying for a visit does not guarantee that telemedicine is appropriate or that a diagnosis, prescription or requested treatment will be provided.
Identity, location and communication
I will provide accurate identifying and contact information and tell the clinician my exact physical address and a reachable callback telephone number at the time of the visit. Luma's current urgent-care service is for adults 18–74, physically located in California or Florida at the time of care. I will notify the clinic if my location or circumstances change before the appointment.
Urgent care currently uses live video. A preference selected on an intake form is a request, not approval of telephone or asynchronous care. The clinic confirms legal and clinical suitability. If my location, age or concern is outside the offered service, the clinician may decline telemedicine and direct me to appropriate care.
Benefits, risks and alternatives
Remote care may make an evaluation more convenient. Risks include incomplete information, limitations of a remote examination, technical interruptions and electronic-communication privacy risks. Alternatives include an appropriate in-person clinician or emergency care. I may ask questions or decline remote care or a proposed treatment. Payment and cancellation consequences are explained separately in the clinic's financial policy; this consent does not waive applicable refund rights.
Privacy and technical interruptions
I will use a private location and device when possible and tell the clinician about anyone else present. The clinic uses its designated telehealth workflow and applicable privacy safeguards; no electronic system can eliminate every privacy risk.
If the connection fails, I will follow the clinic's instructions for reconnecting or contacting the clinic. The clinician will confirm whether and how the evaluation can safely continue; I am not automatically consenting to a telephone or asynchronous substitute.
If Luma cancels or a clinic/platform failure prevents any clinical evaluation, I may choose a full refund or transfer of the full payment to a rescheduled visit, without a no-show penalty, under the separate financial policy. A failed connection is not a reason to delay emergency care.
Routine video recording is off in this urgent-care workflow. This consent does not authorize recording, AI transcription, AI note generation from the visit, model training or marketing. Any proposed additional recording/AI use needs its own reviewed workflow and disclosures/consents as required.
Emergencies
Forms and messages are not monitored for emergencies. For chest pain, severe shortness of breath, stroke symptoms, severe allergic reaction, uncontrolled bleeding, thoughts of harming myself or another person, or another emergency, I will call 911 or seek immediate in-person emergency care instead of waiting for a form, message, callback or scheduled video visit.
Voluntary consent
I have read the telemedicine information, have had the opportunity to ask questions, and consent to a live-video telemedicine evaluation and clinically appropriate care within the scope discussed with my clinician. I may ask questions or decline a proposed treatment. Payment or intake completion does not constitute this consent.
Telemedicine consent is separate from financial acknowledgment, privacy-notice receipt and any authorization to disclose records. No patient answers or signatures have been entered by the clinic or assistant in this document.
Contact
Luma Wellness, LLC
Cordelia Okwuosah, FNP-BC — Practice Manager
1070 Montgomery Rd, Unit 318
Altamonte Springs, FL 32714-7420, US
Telephone: 386-227-7580
Administrative email: contact@golumawellness.com
The address is a mailing contact, not an in-person care location. Do not send medical history or payment-card information in ordinary email; ask for the clinic-designated secure channel. Contact methods are not emergency services.