Telehealth Consent

Telehealth services may include consultations, follow-up visits, evaluations, and treatment recommendations provided through electronic communications.

You understand that:

• Telehealth may not be the same as an in-person visit
• Certain conditions may require an in-person examination
• The provider may determine that telehealth is not appropriate for your condition

Telehealth services involve the electronic transmission of your health information, including but not limited to:

• Medical records
• Diagnoses
• Treatment plans
• Communications with providers

You understand that:

• Electronic transmission of information may be subject to technical failures or unauthorized access
• Your information will not be disclosed without your consent except as permitted by law

You acknowledge that there are potential risks associated with telehealth, including:

• Delays in evaluation or treatment due to technical issues
• Incomplete or inaccurate information due to the absence of a physical examination
• Security risks associated with electronic communication

You accept these risks and agree that neither the Practice nor its providers shall be held responsible for any consequences arising from the use of telehealth services.

Telehealth services are not intended for emergency situations.

If you are experiencing a medical emergency, you agree to call 911 or go to the nearest emergency room immediately.

You understand that alternatives to telehealth include in-person visits with a healthcare provider.

You have the right to choose an in-person consultation instead of telehealth services.

You understand that you have the right to withdraw your consent to telehealth services at any time without affecting your right to future care or treatment.

You understand that:

• Your health information may be shared with healthcare providers and staff as necessary to provide care
• You are responsible for ensuring that your environment is private during telehealth sessions
• The presence of third parties during a session may compromise confidentiality

You understand that you are responsible for all fees associated with telehealth services and that payment may be required prior to receiving services.

You understand that you must be physically located in a state where the provider is licensed at the time of your telehealth visit.

Providers may decline to treat you if you are not located in an approved jurisdiction.

You understand that:

• Prescriptions are issued at the sole discretion of the healthcare provider
• There is no guarantee that a prescription will be provided
• Compounded medications, if prescribed, are not FDA-approved

By using the Platform and receiving telehealth services, you acknowledge that:

• You have read and understand this Consent
• You have had the opportunity to ask questions
• You voluntarily consent to receive telehealth services from providers affiliated with Example Doctor Network, LLC

OndaRx, LLC

Phone: 555-555-5555

Email: compliance@ondarx.com