Patient Intake

HIPAA Authorization

I authorize ProofInjury and its affiliated providers to use and disclose my protected health information (PHI) for purposes of clinical assessment, treatment planning, and medicolegal documentation in connection with my personal injury case.

Telehealth Consent

I consent to participate in telehealth-based clinical assessments, including video-assisted evaluations and computer-vision-based range of motion testing. I understand that these assessments are conducted remotely and may involve AI-assisted analysis.

Medical Lien Acknowledgment

I acknowledge that medical services provided through this platform may be subject to a medical lien. I understand that payment for services may be deferred until resolution of my legal case.

Data Sharing for Legal Proceedings

I authorize the sharing of my assessment data, clinical reports, and AI-generated analyses with my legal representatives for use in legal proceedings related to my personal injury claim.