I authorize Green Bridge Society to communicate with me via email and text message for purposes related to medical evaluations, telemedicine visits, scheduling, billing, and administrative matters.

I understand:

Email and text are not secure communication methods and may be intercepted.
Messages may contain protected health information (PHI), including sensitive topics such as mental health or substance use.
I may revoke this authorization at any time in writing.
My treatment is not conditioned on signing this form.
Once disclosed, PHI may not be protected by federal or state privacy laws.

Effective Period: This authorization remains valid while I am a patient of Green Bridge Society.

By scheduling, I understand I am booking a telemedicine appointment with a Green Bridge Society physician. This appointment is conducted by phone call on the date I select.

Reaching You for Your Appointment

We make every effort to reach you on your scheduled appointment date.
If we are unable to reach you that day, we will attempt to call you again the next day and will also contact you by text and/or email.
If we do not receive a response and are unable to complete the consultation after these attempts, your appointment will be canceled.
If you would like to be added back to the schedule after a cancellation due to no response, a $25 rescheduling fee applies.

Please note: Call times may occur within a scheduled window, and caller ID may display as unknown or appear as spam depending on your carrier. Keeping your phone available on your appointment date helps prevent delays.

This informed consent outlines important considerations related to the use of medical cannabis and the evaluation process.

1. Eligibility & Safety

Patients with schizophrenia or other psychotic disorders cannot be certified by Green Bridge Society.
I agree to disclose any history of depression, psychosis, suicide attempts, or significant mental health concerns.

2. Possible Side Effects

Euphoria, sedation, or dysphoria
Impaired concentration or memory
Dizziness, confusion, anxiety, or paranoia
Delayed reaction time or impaired coordination
Changes in appetite or blood pressure
Possible dependence or withdrawal symptoms

3. Legal Considerations

Smoking cannabis is illegal in Pennsylvania.
Driving under the influence is illegal in all states.
Medical marijuana remains illegal under federal law.
Use is permitted only in private settings.

4. Pregnancy & Mental Health

Marijuana may be harmful during pregnancy.
It may worsen psychotic disorders.

5. Interpreter Disclaimer

Green Bridge Society does not verify interpreter qualifications.
We are not responsible for privacy breaches or miscommunication by interpreters.

6. Treatment Expectations

Green Bridge Society does not dispense or sell cannabis.
We encourage follow-up with your primary care provider for ongoing care.

7. Patient Acknowledgment

I understand and accept the risks and responsibilities associated with medical cannabis. I agree to hold the physician and staff harmless for issues arising from misuse or abuse.

By using this website, you agree to the following terms and conditions.

1. Conditions of Use

By accessing this site, you confirm that you have read and agree to these terms.

2. Age Requirement

You must be at least 18 years old to use this website.

3. Intellectual Property

All content on this website is owned by Green Bridge Society. Unauthorized use, reproduction, or distribution is prohibited.

4. User Accounts

You are responsible for maintaining the security of your login information and for all activities under your account.

5. Applicable Law

These terms are governed by the laws of Pennsylvania.

6. Indemnification

You agree to hold Green Bridge Society harmless against claims arising from misuse of our services.

7. Limitation of Liability

We are not liable for damages resulting from misuse of our website or services.

Green Bridge Society values your privacy. We do not sell or share your personal information.

Information We Collect

Information you provide during scheduling and certification
Documents you upload for diagnosis or identification
Basic analytics used for site performance

How Your Information Is Used

To process appointments
To communicate with you
To meet state medical marijuana program requirements

Your Rights

You may request corrections to your information.
You may revoke HIPAA communication consent at any time.

Refunds are issued under the following conditions:

If the doctor cannot certify you for medical reasons, a full refund is issued.
Once a doctor completes the consultation call, refunds are not issued.
Once a certification is issued to the state, you have 90 days to complete your state registration. If not completed, the state removes your certification and new fees apply.
Diagnostic add-on services (Anxiety, PTSD, Chronic Pain evaluations) are non-refundable.

If you have an issue with our service, we strongly encourage you to contact us directly so we can help resolve the concern.

Important: Disputing a credit card charge after a certification is issued will result in:

Your certification being canceled with the state
Loss of your medical marijuana card
Additional fees from both the doctor and the state to reapply

We will always work with you to resolve any issues — just reach out.

Green Bridge Society — Patient Terms, Consents & Policies