Telehealth Consent Form

Effective Date: April 22, 2022

Nature of Telehealth

Telehealth involves the use of electronic communications

(such as video, audio, or secure messaging) to allow healthcare providers to

deliver clinical services remotely. It may include:

- Evaluation of intake forms and medical history

- Diagnosis and treatment recommendations

- Prescription of medications (if medically appropriate)

- Follow-up and care coordination

Medical Evaluation Limitations

You understand that:

- Telehealth does not allow for a physical examination.

- Your provider is limited to the information you provide.

- Telehealth is not appropriate for all conditions or emergencies.

- If your provider determines that in-person care is needed, you will be

advised accordingly.

Provider Qualifications

You will receive services from licensed U.S.-based

healthcare providers who are authorized to practice in your state of residence.

Prescriptions and Off-Label Use

Medications, including compounded drugs or those used

off-label, may be prescribed based on clinical judgment.

- You acknowledge that certain medications, such as ivermectin, are not

FDA-approved for all uses.

- All prescriptions are issued only after a licensed provider determines they

are medically necessary.

- You will have an opportunity to ask questions before beginning any treatment.

Data Privacy & Security

Your information is protected under the Health Insurance

Portability and Accountability Act (HIPAA).

- All communications and records are stored securely.

- Your data will only be shared with authorized providers, pharmacies, and

vendors involved in your care.

Risks and Benefits of Telehealth

You understand that telehealth offers convenience and timely

access to care, but may also have risks including:

- Incomplete or inaccurate diagnosis due to lack of physical examination

- Delays due to technical failures or incomplete information

- Possible unauthorized access to electronic data (though highly unlikely with

safeguards in place)

Right to Withdraw

You may withdraw your consent to telehealth services at any

time by discontinuing use of GetMedKits. Withdrawal will not affect care

already provided.

Emergency Situations

GetMedKits does not provide emergency medical services.

- If you are experiencing a medical emergency, you must call 911 or go to the

nearest emergency room.

Acknowledgement and Consent

By using GetMedKits, you confirm that:

- You have read, understood, and agreed to the information above.

- You consent to receive care via telehealth.

- You understand you can ask questions at any time by

contacting

[email protected]