Telehealth Consent

Telehealth allows licensed healthcare providers to deliver care using electronic communications and technology instead of an in-person visit. This may include secure video calls, online messages, mobile applications or other digital means that allow for remote communication, diagnosis, treatment, follow-up and patient education.

During a telehealth visit, your provider may:

• Review your medical history and symptoms
• Conduct a visual or verbal assessment
• Recommend laboratory testing or prescribe medications if clinically appropriate

Telehealth visits are designed to provide convenient access to care but are not a substitute for all in-person medical services.

• Easier and faster access to licensed healthcare professionals
• Reduced travel time and scheduling flexibility
• Ability to receive care from home or another private location

Telehealth has some limitations, including:

• In rare cases, technology or internet failures that could interrupt your visit
• Possible delays in evaluation or treatment due to incomplete or inaccurate information
• Limitations on physical examination that may affect diagnostic accuracy
• In rare cases, unauthorized access to personal health information due to security vulnerabilities

If your provider believes that your needs cannot be met through telehealth, you may be referred for an in-person evaluation.

By accepting this consent, you confirm that:

• You are located within a U.S. state where your provider is licensed to practice at the time of your telehealth visit
• You will provide accurate, complete and up-to-date information about your health, symptoms and medications
• You understand that no prescription is guaranteed and that your provider will determine if treatment is medically appropriate
• You may choose to fill any prescription at a pharmacy of your choice

You understand that communication by email, text or other electronic means may not be fully secure, and you accept that risk

Your health information will be handled according to our HIPAA Notice of Privacy Practices and Privacy Policy. We may share your health information with our partner pharmacies, laboratories and licensed medical providers when necessary to provide care and fulfill your treatment plan.

You can review our full Privacy Policy at telewellnessmd.com/privacy-policy.

You understand that you may choose not to use telehealth services. Your provider will assist you in finding an in-person alternative if necessary. Declining telehealth care will not affect your ability to seek treatment elsewhere.

TeleWellnessMD® is not an emergency service. If you believe you are experiencing a medical emergency, call 911 or go to your nearest emergency department immediately.
Our providers cannot diagnose or treat emergency conditions through telehealth.

By proceeding with a telehealth visit, you:

• Give consent for licensed healthcare providers affiliated with TeleWellnessMD® to evaluate and treat you using telehealth technologies
• Authorize the exchange of your medical information with pharmacies, labs or specialists as needed to coordinate care
• Consent to receive communications electronically, including appointment reminders, medical updates and follow-up information

You may withdraw your consent at any time by contacting us at support@telewellnessmd.com or (877) 659-6050, but withdrawal will not affect information previously shared or care already provided.

If you have questions about this Telehealth Consent or our telemedicine process, please contact:

TeleWellnessMD®
2744 Summerdale Dr
Clearwater, FL 33761
support@telewellnessmd.com
(877) 659-6050

By proceeding with a telehealth consultation, you confirm that:

• You have read and understand this Telehealth Consent
• You have had an opportunity to ask questions
• You voluntarily consent to receive care through telehealth from TeleWellnessMD® and its affiliated providers