Informed Consent for Telehealth Services

What Is Telehealth?

Telehealth refers to the delivery of healthcare services using electronic communications and information technology. Through Bold You Wellness, telehealth services are delivered via asynchronous messaging (you complete forms and your provider responds) and/or synchronous video conferencing.

The telehealth services provided through Bold You Wellness include: clinical evaluation of your health history and symptoms; physician review and prescription of medications when clinically appropriate; ongoing monitoring and follow-up; care coaching and wellness support; and coordination of laboratory testing and pharmacy fulfillment.

Your treating provider is an independent licensed physician located and licensed in your state. All clinical decisions are made by your provider using their independent professional judgment.

Benefits of Telehealth

Receiving healthcare via telehealth may offer the following benefits:

• Convenient access to licensed clinical care without travel or waiting rooms
• Faster access to evaluation and prescription than traditional in-person appointments
• Access to specialist care that may not be locally available
• Discreet, private care for sensitive health conditions
• Asynchronous communication that fits your schedule
• Cost savings compared to traditional office visits and brand-name medications
• Continuity of care through messaging and regular check-ins

Risks and Limitations of Telehealth

You understand and acknowledge the following risks and limitations of telehealth care:

• No physical examination: Your provider cannot physically examine you. Certain conditions that would be detectable on physical exam may not be identified through telehealth alone.
• Technology failures: Technical difficulties, connectivity issues, or platform outages may interrupt or delay your care.
• Information security: Although we use security measures described in our Privacy Policy and HIPAA Notice, electronic communications carry inherent risks.
• Clinical limitations: Not all medical conditions are appropriate for telehealth management. Your provider may determine that in-person care is necessary.
• Delayed responses: Asynchronous communication means responses may not be immediate. Telehealth is not appropriate for emergencies.
• Prescribing limitations: Certain medications cannot be prescribed via telehealth under state or federal law.

Your Rights as a Telehealth Patient

As a patient receiving telehealth services, you have the right to:

• Be informed about the nature and purpose of any proposed treatment
• Receive a summary of your telehealth visit upon request
• Request in-person evaluation or referral at any time
• Refuse any recommended treatment without it affecting your right to future care
• Know the identity, professional credentials, and licensing state of your treating provider
• Have your medical records forwarded to any other healthcare provider of your choice
• Withdraw consent from telehealth services and discontinue care at any time
• File complaints with your state medical board or other appropriate regulatory authority

Provider Rights

Your treating provider has the right and professional obligation to:

• Decline to prescribe any medication they deem clinically inappropriate for you
• Require in-person evaluation before initiating or continuing treatment
• Terminate the clinical relationship with appropriate notice if continued telehealth care is not clinically appropriate or if you fail to comply with treatment requirements
• Report information as required by law, including mandatory reporting obligations

Privacy and Security

All communications through the Bold You Wellness platform are conducted over encrypted, HIPAA-compliant infrastructure. Your Protected Health Information is handled in accordance with our HIPAA Notice of Privacy Practices, which is incorporated herein by reference.

You acknowledge that you are responsible for ensuring that your access to the Bold You Wellness platform occurs in a private setting where others cannot see or hear your health information. We recommend using a private network (not public Wi-Fi) when accessing your patient portal.

Your health information will not be shared with your employer, health insurer, or any third party except as described in our Privacy Policy and HIPAA Notice.

Emergencies

If you experience any of the following while on Bold You therapy, seek emergency care immediately:

• Severe abdominal pain, vomiting, or signs of pancreatitis
• Allergic reaction (rash, difficulty breathing, swelling)
• Signs of hypoglycemia (confusion, trembling, rapid heartbeat)
• Any symptom you believe may indicate a medical emergency

After seeking emergency care, please notify your Bold You provider via the patient portal as soon as you are able.

Consent to Compounded Medications

You acknowledge and consent to the following with respect to compounded medications:

• Medications prescribed through Bold You Wellness may be compounded by FDA-registered 503A or 503B pharmacies and are not FDA-approved finished drug products
• Compounded medications contain the same active pharmaceutical ingredients as their brand-name equivalents but may differ in inactive ingredients, concentration, or formulation
• The use of compounded medications involves some degree of variability in potency between batches, within USP tolerances
• Certain uses of medications prescribed through our platform (including microdosing protocols) constitute off-label prescribing, which is a lawful and common medical practice
• You have been informed of these facts and voluntarily consent to receiving compounded medications as prescribed by your treating physician

State-Specific Provisions

Telehealth is regulated at both the federal and state level. Your provider is licensed in your state and complies with applicable state telehealth laws, prescribing regulations, and professional standards.

Specific state requirements may affect the nature and scope of services available to you. For example, some states require an initial video visit before certain medications can be prescribed; others permit fully asynchronous prescribing. Your provider will inform you if state-specific requirements affect your care.

North Carolina, South Carolina, Florida, and Georgia are Bold You's initial service states. We comply with each state's telehealth practice standards and prescribing requirements.

Consent Acknowledgment

Telehealth consent is acknowledged during enrollment in the secure funnel, where patients complete intake and checkout. This page is provided so patients can review the full consent language before enrolling.

• You have read and understand this Informed Consent for Telehealth Services
• You have had the opportunity to ask questions about telehealth care
• You voluntarily consent to receive healthcare services via telehealth through Bold You Wellness
• You understand the benefits, risks, and limitations described in this document
• You consent to the use of compounded medications as described in Section 8
• You understand that this consent does not guarantee any specific clinical outcome or treatment approval
• You may withdraw this consent at any time by notifying Bold You Wellness in writing