Telehealth Informed Consent

This Telehealth Informed Consent applies to telehealth services provided or arranged by euVita Medical Group PLLC (“Medical Group”) and supported administratively by euVita Health, Inc. (“euVita Health”). By scheduling a telehealth visit, participating in a telehealth consultation, or otherwise receiving telehealth services, you acknowledge that you have read, understood, and consent to the terms below.

1. Nature of Telehealth Services

Telehealth involves the delivery of healthcare services through electronic communications, which may include video conferencing, telephone calls, secure messaging, online intake forms, remote patient communications, or other digital tools. Telehealth may be used for consultation, evaluation, diagnosis, treatment recommendations, follow-up care, prescription-related services, care coordination, and other healthcare-related services determined appropriate by a licensed provider.

2. Your Provider; Provider-Patient Relationship

Telehealth services are provided by licensed healthcare providers affiliated with euVita Medical Group PLLC who are licensed in the state where you are located at the time of the visit, as required by law. Before or at the start of your visit, you will be told the name, professional credentials, and licensure of the provider treating you, and you may ask about the provider’s qualifications at any time.

A provider-patient relationship is established only when a licensed healthcare provider accepts responsibility for your care and provides services in accordance with applicable law and professional standards. euVita Health, Inc. provides business, administrative, technology, and non-clinical support services only and does not practice medicine.

3. Benefits of Telehealth

Telehealth may provide improved access to care, convenience, reduced travel time, timely communication, and the ability to receive certain healthcare services remotely.

4. Risks and Limitations

You understand that telehealth has certain risks and limitations, including:

• A remote visit may not be as complete as an in-person examination.
• Certain conditions may require in-person evaluation, testing, emergency care, or specialist referral.
• Technology failures, poor internet connection, audio/video issues, or system interruptions may delay or interrupt the visit.
• Information transmitted electronically may involve privacy or security risks despite reasonable safeguards.
• Delays in evaluation or treatment could occur due to failures of equipment or transmission.
• A provider may determine that telehealth is not appropriate for your condition.

5. Your Rights; Right to Refuse or Withdraw

Your participation in telehealth is voluntary. You have the right to refuse telehealth services, to request in-person services where available, and to withhold or withdraw your consent to telehealth at any time before or during a visit, without penalty and without affecting your right to future care or treatment. You may withdraw consent by notifying your provider, the Medical Group, or euVita Health using the contact information below. Withdrawal of consent will not affect any services already provided before withdrawal.

6. No Emergency Use

Telehealth services are not intended for medical emergencies. If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately.

7. Your Responsibilities

You agree to provide accurate, complete, and current information about your identity, physical location at the time of each visit, medical history, symptoms, medications, allergies, and health condition. You also agree to participate from a private and safe location, use appropriate technology, and promptly inform the provider if your condition changes or if you experience an emergency.

8. Recording

Telehealth visits will not be recorded by the Medical Group or euVita Health without your prior consent, except as required by law. You agree not to record any telehealth visit without the prior consent of your provider.

9. Privacy and Confidentiality

Your health information will be handled in accordance with applicable privacy laws, the euVita Privacy Policy, the Consumer Health Data Privacy Policy, and the Notice of Privacy Practices issued by euVita Medical Group PLLC. The telehealth technology used incorporates reasonable security protections; however, no electronic communication system can be guaranteed to be completely secure.

10. Medical Records

Telehealth services will be documented in your medical record in the same manner as in-person services, as required by applicable law and professional standards. You may request access to or copies of your records as described in the Notice of Privacy Practices.

11. Fees and Billing

euVita operates on a private-pay (self-pay) basis. euVita Medical Group PLLC and euVita Health, Inc. do not bill Medicare, Medicaid, or any private insurance plan on your behalf and are considered out-of-network with all insurance carriers. You are responsible for the full cost of all consultations, lab testing, treatments, medications, and related services.

The fees applicable to your services, including any consultation, membership, or subscription fees, lab fees, and the cost of any prescribed medications or products, will be disclosed to you before you incur them. By proceeding with telehealth services, you authorize euVita to charge the payment method you provide for the services and products you select, and you represent that you are authorized to use that payment method.

Many euVita services may be eligible for payment using a Health Savings Account (HSA) or Flexible Spending Account (FSA); however, eligibility is determined by your plan administrator, and euVita does not guarantee reimbursement. Upon request, euVita can provide an itemized receipt (superbill) that you may submit to your insurer for possible out-of-network reimbursement. Reimbursement is not guaranteed and is solely between you and your insurer.

Payment is charged at the time services are rendered and at the time medications or products are ordered, unless otherwise stated. Consultation and membership fees are non-refundable once services have been rendered. Fees for lab testing and prescribed medications are non-refundable once ordered. If you believe a charge was made in error, contact us at support@euvitahealth.com within 30 days and we will review the charge in good faith. Nothing in this section limits any refund rights you have under applicable law.

12. Prescriptions

Prescriptions, if any, will be issued only when medically appropriate and legally permitted. A provider may decline to prescribe medication or may require additional information, laboratory testing, in-person evaluation, or referral before issuing any prescription.

13. Follow-Up Care and Technical Support

If you have questions after a visit, need follow-up care, or experience technical difficulties before or during a visit, contact us at support@euvitahealth.com or 1 (888) 554-0070. If a telehealth visit is interrupted by a technical failure, we will attempt to reconnect with you or reschedule the visit at no additional charge.

14. State-Specific Requirements

Some states impose additional telehealth consent or disclosure requirements. Where the law of the state in which you are located requires additional disclosures, consents, or procedures, those requirements will be followed and will control over any conflicting provision of this document.

15. Acknowledgment and Consent

By agreeing to this Telehealth Informed Consent, you acknowledge that:

• You understand the nature, benefits, risks, and limitations of telehealth.
• You understand that telehealth is not appropriate for emergencies.
• You have had the opportunity to ask questions and have had them answered to your satisfaction.
• You understand that your participation is voluntary and that you may refuse or withdraw consent at any time without affecting your right to future care.
• You consent to receive healthcare services through telehealth where medically appropriate.
• You understand that a provider may recommend in-person care if necessary.

16. Contact Information

Administrative support provided by euVita Health, Inc. at the same address.