Consent to Telehealth

1. What Is Telehealth?

Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up, patient education, and prescription management. Communications may include secure messaging, video consultations, phone calls, and electronic health questionnaires.

2. Benefits of Telehealth

The potential benefits of telehealth include:

• Easier and more efficient access to healthcare, particularly for those in underserved areas or with limited mobility.
• Convenient scheduling without the need for in-person office visits or travel.
• Reduced exposure to contagious illness in waiting rooms.
• Ability to consult with healthcare providers from the privacy and comfort of your home.
• Efficient follow-up care and ongoing treatment monitoring.

3. Risks and Limitations of Telehealth

As with any medical service, telehealth has potential risks and limitations, including:

• Limited physical examination: Your healthcare provider cannot perform a hands-on physical examination, take vital signs, or conduct in-person diagnostic tests. This may limit the provider's ability to diagnose certain conditions.
• Technology limitations: Technical difficulties, including poor internet connection, software errors, or equipment failures, may interrupt or delay your consultation. In rare cases, technology failures could result in errors in medical judgment due to insufficient transmitted information.
• Privacy and security: While we use encryption and security measures designed to protect your health information, electronic communications carry inherent risks of interception or unauthorized access. No technology is completely secure.
• Prescription limitations: Certain medications may not be prescribed via telehealth due to state or federal regulations. Your provider's ability to prescribe may vary based on your location and applicable laws.
• Not suitable for all conditions: Telehealth is not appropriate for all medical situations. Your healthcare provider may determine that an in-person visit is necessary and may refer you to local care.
• Incomplete medical records: If your healthcare provider does not have access to your complete medical history, there is a risk that incomplete information could affect clinical decisions, including potential adverse drug interactions.

4. Alternatives to Telehealth

Telehealth is not your only option for receiving healthcare. You may choose to receive in-person care from a local healthcare provider at any time. You are not required to use telehealth services, and you may discontinue telehealth at any time without affecting your right to future care or treatment. If you choose to discontinue telehealth, we can provide your medical records to facilitate continuity of care with another provider.

5. Healthcare Providers

Healthcare services are provided by independent, licensed healthcare providers, which may include physicians (MDs and DOs), nurse practitioners (NPs), and physician assistants (PAs), depending on the services requested and your state of residence. All providers are licensed in the state where you are located at the time of service. Providers exercise independent clinical judgment in all diagnostic, treatment, and prescribing decisions. FormBlends does not control or direct the clinical decisions of healthcare providers.

6. Compounded Medications

If your healthcare provider prescribes a compounded medication, you understand that compounded medications are prepared by FDA-registered 503B outsourcing facilities and are not FDA-approved as finished products. Compounded medications have not been evaluated by the FDA for safety, effectiveness, or quality. The decision to prescribe a compounded medication is made by your healthcare provider based on their independent medical judgment and your individual clinical needs. Compounded medications are typically not covered by insurance. You have the right to discuss the risks and benefits of compounded medications with your healthcare provider before beginning treatment.

7. Privacy and Confidentiality

We use technology designed to protect your privacy, including encrypted communication channels and secure data storage. We recommend you use a private internet connection and a private location when participating in telehealth consultations. Despite these safeguards, there is a small inherent risk that electronic communications could be intercepted. For more information about how we protect your data, please review our Privacy Policy.

8. Your Obligations

By using telehealth services through FormBlends, you agree to:

• Provide complete and accurate medical history and health information.
• Promptly inform your healthcare provider of any changes in your health, medications, or adverse reactions.
• Accurately report the state in which you are physically located at the time of each consultation.
• Follow your prescribed treatment plan and attend recommended follow-up consultations.
• Seek emergency care by calling 911 if you experience a medical emergency.

9. Your Rights

You have the right to:

• Withdraw your consent to telehealth at any time, without affecting your right to future care.
• Request a copy of your medical records in accordance with applicable laws.
• Request that your prescriptions be transferred to any licensed pharmacy of your choice.
• Ask questions about your diagnosis, treatment options, and the qualifications of your healthcare provider.
• Refuse any proposed treatment or medication.

To withdraw consent or exercise any of these rights, contact us at support@formblends.com.

10. Financial Disclosure

FormBlends has a financial relationship with the healthcare providers and pharmacy partners who deliver services through our platform. This disclosure is provided so you can make an informed decision about your care. Your healthcare provider's clinical decisions are independent and are not influenced by FormBlends.

11. Acknowledgment

By using telehealth services through FormBlends, you acknowledge that you have read and understood this Consent to Telehealth, including the benefits, risks, and alternatives described above. You consent to receive healthcare services via telehealth. You understand that this consent applies to all current and future telehealth interactions through the FormBlends platform until you withdraw your consent in writing.

12. Contact

For questions about this Consent to Telehealth or our services, contact us at support@formblends.com or visit our contact page.