Informed Consent for Telehealth Services

1. What Telehealth Is

Telehealth is the use of secure electronic communications — such as live video, audio, secure messaging, and the exchange of health information — to deliver clinical care when you and your clinician are in different locations. During a telehealth visit, a VCMG clinician can review your history, discuss your symptoms, evaluate your condition, recommend a treatment plan, order tests, and, when clinically appropriate, prescribe medication. Telehealth is a method of delivering care; it is not a separate kind of medicine, and the same professional standards apply as for in-person visits.

2. Services We Provide

VCMG offers physician-led virtual care across the following service lines:

• Urgent Care — evaluation and treatment of acute, non-emergency conditions such as colds and flu, infections, rashes, and allergies.
• Behavioral Health — virtual counseling and psychiatric support for conditions such as anxiety, depression, and stress.
• Primary Care — ongoing care including preventive screenings, chronic-condition management, prescription renewals, and routine follow-up.
• Weight Loss — clinician-guided weight management that may include medical evaluation, GLP-1 medication when appropriate, lab review, and ongoing monitoring.

Not every condition can be evaluated or treated by telehealth. Your clinician will tell you if your needs would be better addressed by an in-person visit or a referral, and may decline to provide a service by telehealth when doing so is not in your best interest.

3. Benefits of Telehealth

• Convenient access to licensed clinicians without travel;
• Care from the comfort and privacy of your own home;
• Shorter wait times and more flexible scheduling, including after-hours urgent care;
• Easier follow-up and continuity of care between visits; and
• Timely access to clinical guidance that may help you avoid unnecessary in-person visits.

4. Risks and Limitations

As with any care, telehealth has potential risks and limitations. You should understand that:

• Your clinician cannot perform a hands-on physical examination, which may limit the ability to make a diagnosis;
• In some cases, information transmitted may be insufficient (for example, poor image quality), and your clinician may determine that telehealth is not appropriate and that an in-person visit is needed;
• Technical problems — such as connection failures, equipment issues, or delays — may interrupt or end a visit;
• Rarely, security protocols could fail, causing a breach of privacy; and
• A delay in evaluation or treatment could occur if the technology or transmitted information is inadequate.

Your clinician will use professional judgment to decide whether your condition can be safely managed by telehealth and will recommend alternatives when appropriate.

5. Not for Emergencies

6. Technology, Privacy, and Security

VCMG uses technology designed to protect the privacy and security of your information, consistent with HIPAA and applicable law. The privacy laws that protect your health information apply to telehealth, and your protected health information is governed by VCMG's Notice of Privacy Practices. Where a service provider handles your information on our behalf, it does so under a business associate agreement. You should take reasonable steps to protect your own privacy as well — for example, by joining your visit from a private location on a secure internet connection. Visits are not recorded without your knowledge and consent except as permitted by law.

7. Prescribing and Medications

When clinically appropriate, your VCMG clinician may prescribe medication during a telehealth visit. Whether a prescription is appropriate is a clinical decision; you are not guaranteed any particular medication, and your clinician may decline to prescribe when it would not be safe or appropriate. The prescribing of controlled substances by telehealth is limited by federal and state law, including the Ryan Haight Act, and certain medications cannot be prescribed without an in-person evaluation. For weight-management care, any GLP-1 or other prescription medication is offered only after medical evaluation and only when clinically appropriate, and may require lab work and ongoing monitoring.

8. Licensure and Where We Practice

VCMG clinicians are licensed, credentialed, and privileged in accordance with applicable state and federal requirements, and provide care only in states where they are authorized to practice. You must generally be physically located in a state where your clinician is licensed at the time of your visit. You agree to tell us your current location at the start of each visit so we can confirm that care can be provided lawfully and route you appropriately.

9. Your Responsibilities

• Provide complete and accurate information about your health history, symptoms, medications, and allergies;
• Confirm your identity and current physical location when asked;
• Follow the treatment plan and instructions your clinician provides, and ask questions if anything is unclear;
• Attend recommended follow-up visits and seek in-person or emergency care when advised; and
• Keep your contact information current so we can reach you about your care.

10. Your Rights and Right to Withdraw

Your participation in telehealth is voluntary. You have the right to ask questions about your care, to request an in-person referral, and to decline or stop a telehealth visit at any time without affecting your right to future care or any benefits to which you are otherwise entitled. You may withhold or withdraw this Consent at any time by notifying your clinician or contacting us at the email below; withdrawal applies going forward and does not affect care already provided.

11. Financial and Billing Information

You are responsible for any fees, copays, coinsurance, or other amounts associated with your care, as disclosed to you before your visit. Coverage for telehealth varies by plan; you are responsible for understanding your own coverage. When VCMG providers deliver care to Medicare-eligible patients, VCMG is the billing entity of record for those services, including eligible video visits as required by federal regulations.

12. Florida Telehealth Acknowledgment

For care provided to patients located in Florida, telehealth is delivered in accordance with Florida's telehealth laws and the rules of the applicable Florida licensing boards. A Florida-licensed clinician (or a clinician otherwise authorized to provide telehealth to Florida patients under applicable registration requirements) is responsible for the standard of care. You acknowledge that the standard of care for a telehealth visit is the same as for an in-person visit and that your clinician will determine whether your condition can be appropriately evaluated and treated by telehealth.

13. Consent and Acknowledgment

Questions