Informed Medical Consent
Patient Evaluation Agreement • Effective Date: August 2026
I acknowledge that TintExemption provides administrative and technology services that connect me with a licensed medical healthcare professional (“Provider”) through its secure online platform for medical evaluation regarding light sensitivity, migraines, photophobia, and statutory window tint exemptions.
Online Medical Evaluation Modality
Online evaluations include medical history review, clinical questionnaire assessment, secure transmission of health information, electronic communication, and document review using interactive digital forms. I understand that my reviewing Provider is an independent contractor and not an employee of TintExemption.
Expected Benefits of Online Evaluation
I understand that the expected benefits of an online medical evaluation include:
1. Improved access to state-licensed physicians without visiting a physical clinic.
2. Efficient and prompt medical questionnaire evaluation and certificate delivery.
3. Direct review by providers licensed in my state of vehicle registration.
Confidentiality & Medical Privacy
I understand that I have the same rights to confidentiality with online evaluations as I would for in-person medical care. Any information disclosed by me during the course of my evaluation is strictly confidential to the extent provided by state law and protected under federal HIPAA standards.
Patient Acknowledgments
By proceeding and submitting my intake, I understand and agree to the following:
1. I consent to receiving online medical evaluation services from my assigned licensed Provider.
2. I have the right to withhold or withdraw my consent to online evaluation at any time without affecting my right to future care.
3. All clinical and personal information I submit is accurate, truthful, and complete to the best of my knowledge.
4. If the Provider determines that an online review is insufficient for my specific symptoms, I may be advised to undergo an in-person clinical examination.
5. TintExemption does not provide emergency medical services. In a medical emergency, I will dial 911 immediately.
6. TintExemption does not guarantee certification approval, which remains under the independent clinical discretion of the physician pursuant to state motor vehicle statutes.
Consent & Authorization
By checking the consent agreement during checkout, I confirm that I have read and agree to this Informed Consent. An electronic copy of this agreement shall be treated with the same validity as an original signed document.
Contact Information
Tint Exemption LLC
971 US Highway 202 N, Suite R, Branchburg, NJ 08876
Phone: (888) 318-3199
Email: contact@tintexemption.com