Telehealth Informed Consent

Last updated: September 2026

This consent describes how telehealth services are delivered through the MyRxProvider platform ("Platform"). Please read it carefully. By checking the consent box during intake, you agree to receive care via telehealth under the terms below.

1. What telehealth is

Telehealth is the delivery of healthcare services using electronic communications — including secure questionnaires, messaging, phone, and video — between you and a licensed healthcare provider who is not in the same physical location as you. Your provider may use telehealth to evaluate your health history, diagnose, recommend treatment, and prescribe medication where clinically appropriate and legally permitted.

2. Expected benefits

• Convenient access to licensed providers without travel or time away from work.
• Timely evaluation, follow-up, and medication management.
• Secure electronic access to your records and care team.

3. Possible risks and limitations

• Telehealth is not a substitute for in-person care in every situation. Your provider may determine that your condition requires an in-person examination, lab work, or referral, and may decline to treat you via telehealth.
• Information transmitted electronically may be insufficient (e.g., image quality, incomplete history) to allow appropriate decision-making, which could result in delays in evaluation or treatment.
• Although industry-standard security protections are used, electronic systems carry an inherent risk of failure or unauthorized access.
• Delays may occur due to technology failures or scheduling constraints.

4. Not for emergencies

Telehealth services are not appropriate for medical emergencies. If you are experiencing a medical emergency — including chest pain, difficulty breathing, severe abdominal pain, signs of a severe allergic reaction, or thoughts of harming yourself or others — call 911 or go to the nearest emergency room immediately.

5. Your responsibilities

• Provide accurate, complete, and current information about your health, medications, and allergies. Providers rely on your answers to treat you safely.
• Be physically located in the state you identified during intake at the time of each telehealth encounter.
• Notify your care team of any changes in your health, new medications, pregnancy, or side effects.
• Maintain a relationship with a local primary care provider where possible.

6. Your rights

• You may withhold or withdraw this consent at any time without affecting your right to future care or benefits to which you are otherwise entitled.
• You have the right to know the identity, licensure, and credentials of the providers treating you, upon request.
• You may request a copy of your medical records as described in the Notice of Privacy Practices.
• Alternative options, including in-person care, are available to you and you may choose them at any time.

7. Prescriptions

No medication is guaranteed. Prescriptions are issued solely at the professional judgment of a licensed provider following an appropriate evaluation. You are free to fill any prescription at a pharmacy of your choice.

8. Privacy

The laws that protect the confidentiality of your medical information, including HIPAA, apply to telehealth. See our Privacy Policy & Notice of Privacy Practices for details. Your employer does not receive your individual health information.

9. Acknowledgment

By checking the Telehealth Informed Consent box during intake, you confirm that you have read and understood this document, that your questions (if any) have been answered, and that you consent to receive healthcare services through the Platform via telehealth.