Our clinic can offer you a blood pressure cuff or weight scale that automatically sends the numbers to our clinic, and this would be covered by your insurance (the clinic will verify first). If you are interested, choose one:
Cellular Blood Pressure Monitor
Cellular Weight Scale
Remote Patient Monitoring Consent
Are you the patient?
If you are signing for the patient, please answer the following:
I am permitted to sign for the patient as I am their legal guardian/medical power of attorney/decision maker.
My name is
and my relationship to the patient is
Patient's Date of Birth (MM-DD-YYYY):
Should be Empty: