Myhealthform

Terms of Service

Effective Date: November 9, 2025

These Terms of Service (“Terms”) govern your access to and use of the website MyHealthForm.com (“the Site”) and any related services provided by MyHealthForm.com (“the Company,” “we,” “us,” or “our”). By creating an account, submitting information, or checking the box to indicate your acceptance, you agree to be bound by these Terms. If you do not agree, you may not access or use this Site.

  1. Purpose of Service

MyHealthForm.com provides an online process that allows caregivers, healthcare workers, and similar individuals to obtain documentation verifying that they are “free from communicable disease.” This documentation is based on information you submit and review under a physician-approved screening protocol.

This service does not provide medical diagnosis, treatment, or advice. The screening is limited to documentation purposes only and is not a substitute for a physical examination or other healthcare services. By using this Site, you acknowledge that no patient-provider relationship is created between you and any affiliated physician.

Regulatory Alignment
The screening process and documentation format were developed to align with applicable requirements under Florida Statutes, Chapter 400, Part III and Florida Administrative Code Rule 59A-18, which govern nurse registries and caregiver documentation of being free from communicable diseases.

Details of this process and protocol have been shared with the Deputy Secretary for Health Quality Assurance at the Florida Agency for Health Care Administration (AHCA) for review and informational purposes. MyHealthForm.com is an independent documentation service and does not claim formal endorsement or approval by AHCA.

  1. Account Creation and User Responsibilities

To use this service, you must create an account and provide accurate and complete information. You are responsible for maintaining the confidentiality of your login credentials and for all activity under your account.

You agree not to:
• Provide false or misleading information.
• Access or attempt to access another user’s account.
• Interfere with or disrupt the Site’s operation.

MyHealthForm.com reserves the right to suspend or terminate accounts for any misuse or violation of these Terms.

  1. Payments and Refunds

All fees for screenings and related documentation are due at the time of submission. Payments are processed through our secure third-party payment system.

Once your submission has been processed, payments are non-refundable, regardless of whether documentation is approved or issued. Fees cover administrative processing and documentation only and do not guarantee any particular outcome or acceptance by third parties.

Payment includes access to MyHealthForm.com and related screening services for six (6) months from the date of payment. At the end of this period, users may make an additional payment to renew access and obtain an updated statement. All renewed statements will reflect the original payment date as the basis for the issuance period.

Users who do not initially pass screening will retain access for the balance of the six-month period to allow time to visit a healthcare provider or manage any identified communicable disease as directed by their primary healthcare provider.

Expired forms will be maintained for all users under their individual profiles to ensure ongoing access to historical documentation for personal or compliance purposes.

  1. Description and Limitations of Screening

The communicable disease screening process used by MyHealthForm.com is conducted under a standardized physician-approved protocol for documentation purposes. It does not include a physical examination, diagnostic testing, or medical clearance for employment.

By using the Site, you acknowledge that MyHealthForm.com does not provide medical care, medical advice, or laboratory services and does not replace an evaluation by a licensed healthcare provider.

  1. Use of Personal Information and Authorization

By submitting information through this Site, you authorize MyHealthForm.com to collect, store, and use the personal and limited health-related information you provide for the purposes of processing your screening, creating documentation, maintaining records, and improving services.

You further consent and authorize MyHealthForm.com to share or sell your contact information, which may include your name, phone number, email address, and general caregiver profile, to businesses seeking to contact caregivers or individuals providing similar services. No medical records or confidential health evaluations will be sold.

By using this Site, you waive and release any claim arising from the collection, use, or authorized disclosure of your submitted information consistent with these Terms.

  1. Data Privacy and Security

MyHealthForm.com is not a “covered entity” under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). However, we maintain reasonable administrative, technical, and physical safeguards designed to protect your information from unauthorized access, disclosure, or misuse.

We may retain your information as required by law, as necessary to maintain records of documentation, or as reasonably needed for legitimate business purposes.

  1. Communications and Electronic Records

By providing your contact information, you consent to receive communications from MyHealthForm.com electronically, including through email or text message. You agree that electronic notices, disclosures, and records satisfy any legal requirements that such communications be in writing.

  1. Intellectual Property

All content on MyHealthForm.com, including text, graphics, logos, and other materials, is the property of MyHealthForm.com and is protected by copyright and other intellectual-property laws. You may not reproduce, distribute, or create derivative works without prior written consent.

  1. Disclaimers and Limitation of Liability

The services provided through MyHealthForm.com are offered “as is” and without warranties of any kind, whether express or implied. MyHealthForm.com makes no guarantees regarding the accuracy or acceptance of any documentation issued through the Site.

To the maximum extent permitted by law, MyHealthForm.com and its affiliates shall not be liable for any indirect, incidental, consequential, or special damages arising out of or in connection with your use of the Site or services.

Your sole remedy for dissatisfaction with the Site or services is to discontinue use.

  1. Arbitration and Dispute Resolution

Any dispute, claim, or controversy arising out of or relating to these Terms, the Site, or any services provided by MyHealthForm.com shall be resolved by binding arbitration administered by the American Arbitration Association (AAA) under its Commercial Arbitration Rules.

The arbitration shall take place in Lee County, Florida, and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction. You agree to arbitrate disputes individually and waive the right to participate in any class or representative action.

Either party may bring a qualifying claim in small-claims court in Lee County, Florida, instead of arbitration.

  1. Governing Law

These Terms shall be governed by and construed in accordance with the laws of the State of Florida, without regard to its conflict-of-law provisions.

  1. Changes to These Terms

MyHealthForm.com reserves the right to modify or update these Terms at any time without prior notice. Continued use of the Site after changes are posted constitutes acceptance of the revised Terms.

  1. Contact Information

For questions or concerns about these Terms or the use of your information, contact:
Email: [email protected]
Phone: (239) 766-8238

Acknowledgment

By creating an account and checking the box indicating your agreement, you acknowledge that you have read, understood, and agree to be bound by these Terms of Service.