Telehealth Informed Consent

1. Who provides your care

HealifyMD is a technology and administrative platform. It does not practice medicine. Your care is provided by an independently licensed clinician ("your clinician"), such as a physician, nurse practitioner or physician assistant, who is licensed in the state where you are located. Prescriptions are filled by independent licensed pharmacies, and lab tests are performed by independent clinical laboratories.

2. What telehealth is

Telehealth means receiving health care services from a clinician who is not in the same place as you, using technology such as video visits, secure messaging, online questionnaires and electronic transfer of images and test results. Your clinician may review your information without you present (asynchronous care) or meet with you in real time by video or audio (synchronous care), depending on your needs and the laws of your state.

Your clinician cannot physically examine you. They will rely on the information you provide, any photos or measurements you share and test results. Your clinician may decide that telehealth is not appropriate for your situation and recommend an in-person visit, tests or a specialist.

3. Potential benefits

• Access to care without traveling to an office.
• Easier scheduling and follow-up.
• The ability to share information and test results electronically.
• Ongoing communication with your care team between visits.

4. Potential risks and limitations

• Your clinician cannot perform a physical exam, which may limit or delay a diagnosis or lead to a different recommendation than an in-person visit would.
• Information you provide may be incomplete or inaccurate, which could affect your care.
• Technology failures, such as poor connections or software problems, may interrupt or delay visits.
• Despite reasonable security measures, electronic information could be accessed by unauthorized people.
• Delays in evaluation or treatment could occur because of technical problems or the time needed to review your information.
• In rare cases, a lack of access to complete records could result in medication interactions, allergic reactions or other judgment errors.

5. Emergencies

Telehealth through HealifyMD is not for emergencies or urgent problems. If you have symptoms such as chest pain, trouble breathing, sudden weakness or numbness, severe abdominal pain, a severe allergic reaction, fainting or thoughts of harming yourself or others, call 911 or go to the nearest emergency room. You can reach the Suicide and Crisis Lifeline by calling or texting 988. Do not wait for a reply to a message.

6. Your responsibilities

• Provide complete, accurate and current information about your health, medications, supplements, allergies and history, and update it when anything changes.
• Be physically located in a state where your clinician is licensed during each visit, and tell your care team your actual location.
• Follow your clinician's instructions, including for labs and follow-up visits.
• Use medications only as prescribed and only for yourself, and report side effects promptly.
• Keep a primary care clinician for routine and preventive care, and seek in-person care when advised.
• Keep your account credentials secure.

7. Clinical decisions and prescriptions

Your clinician decides, using their independent professional judgment, whether to recommend or prescribe any treatment. There is no guarantee that you will receive a prescription or a particular medication, dose or outcome. Your clinician may change or stop a treatment, may require labs or a live visit before prescribing and may decline to continue care if it is not safe or appropriate.

8. FDA-approved, off-label and compounded treatments

Some treatments your clinician recommends may be FDA-approved for the use in question. Others may be FDA-approved medications used off-label, meaning for a purpose, dose or population not included in the FDA-approved labeling. Off-label use is legal and common, but the FDA has not reviewed that specific use.

Some treatments are compounded by licensed pharmacies. Compounded medications are not FDA-approved. The FDA does not review them for safety, effectiveness or quality before they are dispensed, and they are not the same as branded or generic FDA-approved drugs. Some substances, including several peptides, have limited human evidence and a regulatory status that may change. Your clinician will explain why a treatment is recommended, what is known and not known about it, the alternatives (including FDA-approved options and no treatment) and its risks. You may ask questions and decline any treatment.

9. Laboratory testing and monitoring

Your clinician may require lab tests before or during treatment to judge whether it is safe and how well it is working. Results can be affected by timing, fasting, exercise, supplements, illness and other factors, so follow preparation instructions. Lab tests do not diagnose or rule out every condition, and some specialty tests are laboratory-developed tests that are not FDA-approved or cleared. Skipping required monitoring may mean your clinician cannot safely continue a treatment.

10. Privacy and records

Your health information will be handled as described in our HIPAA Notice of Privacy Practices and Privacy Policy. Your clinician will keep a record of your telehealth care, and information may be shared with pharmacies, laboratories and others involved in your care as those documents describe. Video visits are not recorded without your consent.

11. Alternatives and your right to withdraw

Alternatives to telehealth include in-person care with your own clinician or a specialist. Participation is voluntary. You may withdraw your consent and stop using telehealth at any time by telling your care team or emailing support@healifymd.com, without affecting your right to future care elsewhere. Ask your clinician before stopping a medication, since some should be tapered.

12. Your acknowledgment

By accepting this consent, you confirm that you are at least 18 years old; that you have read this document and had the chance to ask questions; that you understand the benefits, risks and limitations of telehealth, including those related to off-label and compounded treatments; that the information you provide will be accurate and complete; and that you consent to receive care via telehealth from independently licensed clinicians using the HealifyMD platform.