Telehealth Informed Consent

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This Telehealth Informed Consent ("Consent") applies to telehealth services provided through the website, patient portal, and related services offered by Elm Health LLC ("Elm Health," "Company," "we," "our," or "us").

By proceeding with a telehealth consultation, completing a medical intake form, or receiving services through the platform, you acknowledge that you have read, understood, and agree to the terms of this Consent.

1. Nature of Telehealth Services

Telehealth involves the delivery of healthcare services using electronic communications, technology platforms, and other remote means between a patient and a licensed healthcare provider.

Telehealth services may include:

  • Medical evaluations

  • Health assessments

  • Treatment recommendations

  • Prescription management

  • Follow-up care

  • Patient education

Healthcare providers may review information submitted through questionnaires, patient portals, messaging systems, photographs, video consultations, audio consultations, or other electronic means.

2. Provider Determination

I understand that completing a medical intake form, consultation, or payment does not guarantee treatment, diagnosis, medication, or a prescription.

All treatment decisions are made solely by the licensed healthcare provider based on their independent medical judgment.

A provider may determine that telehealth is not appropriate for my condition and may recommend in-person care.

3. Potential Benefits

Potential benefits of telehealth include:

  • Improved access to healthcare

  • Increased convenience

  • Reduced travel time

  • Greater continuity of care

  • Faster communication with providers

4. Potential Risks

I understand that telehealth services involve certain risks, including but not limited to:

  • Technical failures or interruptions

  • Delays in evaluation due to incomplete information

  • Limitations associated with remote assessment

  • Unauthorized access despite security measures

  • Possible misunderstandings caused by electronic communication

I understand that no guarantees can be made regarding treatment outcomes.

5. Medical Information and Accuracy

I certify that the information I provide is accurate, complete, and truthful to the best of my knowledge.

I understand that withholding information, providing inaccurate information, or failing to update medical information may affect treatment decisions and patient safety.

6. Privacy and Confidentiality

I understand that my health information may be collected, used, and disclosed as necessary to provide healthcare services, process prescriptions, coordinate pharmacy fulfillment, process payments, and comply with legal obligations.

Information may be shared with:

  • Licensed healthcare providers

  • Licensed pharmacies

  • Clinical support personnel

  • Technology service providers

  • Payment processors

  • Regulatory agencies when required by law

Reasonable security measures are used to protect patient information; however, no electronic system can guarantee absolute security.

7. Prescription Services

If a provider determines that treatment is appropriate, prescriptions may be transmitted electronically to a licensed pharmacy.

I understand that:

  • Prescriptions are not guaranteed

  • Providers may decline treatment at their discretion

  • Pharmacies maintain independent control over medication fulfillment

  • Medication availability may vary

8. Emergency Situations

Telehealth services are not intended for medical emergencies.

If I experience a medical emergency, I will immediately call 911 or seek emergency medical care.

9. Financial Responsibility

I understand that I am responsible for all applicable fees, subscription charges, treatment costs, pharmacy charges, and other fees disclosed during enrollment.

I understand that recurring subscriptions may automatically renew unless canceled in accordance with the applicable Terms and Conditions.

10. Voluntary Participation

I understand that participation in telehealth services is voluntary.

I may withdraw my consent for future telehealth services at any time by discontinuing use of the platform and notifying Elm Health, subject to any obligations related to ongoing treatment, billing, or prescription fulfillment.

11. Acknowledgment and Consent

By using the Services, I acknowledge and agree that:

  • I have read and understand this Telehealth Informed Consent.

  • I understand the nature, benefits, and risks of telehealth services.

  • I have had the opportunity to review information regarding telehealth care.

  • I consent to receive healthcare services through telehealth technologies.

  • I consent to the use and disclosure of my information as necessary to provide healthcare services.

  • I understand that treatment and prescriptions are not guaranteed.

  • I voluntarily agree to receive services through telehealth.

By continuing, I provide my electronic consent and agree to this Telehealth Informed Consent.

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