Telehealth Informed Consent

1What telehealth means here

Telehealth is the delivery of health care using electronic communications rather than an in-person visit. Through CoreScripts, telehealth generally takes the form of asynchronous (store-and-forward) review: you complete a written medical intake and upload any requested information, and a licensed clinician reviews it and responds through the secure portal. Your clinician may also require a live audio or video visit, laboratory testing, or records from another provider before making any decision.

You will be matched only with a clinician holding an active, unrestricted license in the state where you are physically located at the time of the encounter. Your clinician’s name, credentials, and license number appear in your patient portal.

2Expected benefits

• Access to a licensed clinician without travel or time away from work.
• A documented medical history reviewed before any prescribing decision is made.
• Ongoing monitoring, dose adjustment, and secure messaging with your care team.
• Prescriptions, when appropriate, sent to a licensed U.S. pharmacy without a separate trip.

3Risks and limitations — read this part

Other risks include:

• Technology failure. Connectivity problems, transmission errors, or image quality can delay or degrade the evaluation.
• Security. Although the platform uses encryption and other safeguards, no electronic transmission is perfectly secure, and there is a small risk of unauthorized access.
• Delay. Asynchronous review is not immediate. It is not appropriate for urgent or emergency problems.
• Referral. Your clinician may determine that telehealth is not appropriate for your situation and direct you to in-person care.
• Adverse reactions. Any medication can cause side effects, some serious, and reactions cannot be observed remotely in real time.

4This is not emergency care

5No guarantee of a prescription or a result

Completing the intake does not create a prescription and does not obligate any clinician to write one. Your clinician may decline to prescribe, may prescribe something different from what you expected, may require testing or a live visit first, or may refer you elsewhere. Those are legitimate clinical outcomes.

No specific outcome, result, or benefit is guaranteed. The medication offered is a compounded preparation that is not FDA-approved and is not approved to prevent, treat, or cure any disease. See the Important Safety Information.

6Your responsibilities

• Provide complete, accurate, and current information about your health, your medications, and your allergies, and update it when it changes.
• Be physically located in the United States, in a state where your clinician is licensed, at the time of the encounter.
• Be in a private setting where you are comfortable discussing health information.
• Follow the dosing instructions your clinician provides, and do not adjust the dose on your own.
• Report side effects promptly, and seek in-person or emergency care when your symptoms warrant it.
• Maintain a relationship with a primary care provider. Telehealth through this platform is not a substitute for comprehensive primary care.

7Records, privacy, and recording

Information disclosed during a telehealth encounter is part of your medical record and is protected under HIPAA and applicable state law, as described in the Notice of Privacy Practices.

You may not record any consultation without the prior written consent of your clinician. The Practice does not record video visits except where you are told in advance and consent.

8Your right to withdraw

You may withhold or withdraw this consent at any time without affecting your right to future care or treatment, and without penalty. To withdraw, notify your care team through the portal or email support@getCoreScripts.com.

You always have the alternative of an in-person evaluation. If you prefer one, or if your clinician recommends one, we will tell you so plainly.

9What you are agreeing to

By accepting this consent you confirm that:

• You have read and understood this document, and you have had the opportunity to ask questions;
• You understand the benefits, risks, and limitations of telehealth described above;
• You understand that no prescription and no particular result is guaranteed;
• You are 18 or older and physically located in the United States;
• The information you provide is true and complete to the best of your knowledge; and
• You consent to receive care by telehealth from a clinician of the Practice.