Informed Consent for Telehealth Services and Medication Treatment

This Informed Consent document describes the nature, benefits, risks, and limitations of receiving healthcare through Teledris Health's telehealth platform. It also describes your rights and responsibilities as a patient. If prescribed, medication-specific disclosures will be provided separately for the specific medication you receive.

Teledris Health, operated by Teledris LLC, is located at 8 The Green, STE 12393, Dover, DE 19901. Care is delivered by licensed clinicians employed by or contracted through our affiliated professional entity. Clinical review and electronic prescribing are facilitated through our third-party telehealth services partner, MD Integrations, which operates the telehealth platform and connects you with its network of independently licensed clinicians.

This document does not replace your relationship with your treating clinician. You may ask questions at any time, and you may withdraw your consent at any time without penalty for future care, although you may remain responsible for charges already incurred.

Telehealth is the delivery of health care services using interactive electronic communication, including secure messaging, written intake forms, video, audio, photos, and data transmission, to evaluate, diagnose, and treat patients without an in-person visit.

Teledris Health uses both:

• Asynchronous, or store-and-forward, telehealth, in which you submit information through a secure platform and a clinician reviews it later.
• Synchronous telehealth, in which you and a clinician communicate in real time by video or telephone.

Most Teledris Health visits begin asynchronously. Live audio or video visits may be required by your state of residence, by your clinical situation, or at the clinician's discretion.

• Convenient access to licensed clinicians without travel.
• Care from your home or another private location.
• Faster scheduling than many traditional in-person practices.
• Continuity of care through ongoing secure messaging.
• Bilingual support in English and Spanish.

Telehealth has limitations that do not exist in an in-person visit. By consenting to telehealth, you acknowledge that you understand and accept these limitations:

1. No physical examination. Some conditions cannot be diagnosed or treated safely without an in-person examination.
2. Information accuracy. The accuracy of any diagnosis or treatment plan depends on the accuracy and completeness of the information you provide.
3. Technology failures. Internet outages, dropped calls, software errors, or device malfunction may interrupt or delay care.
4. Privacy and security. We use industry-standard encryption and security measures, but no system is completely secure.
5. Recording, transmission, and storage of PHI by Teledris Health and authorized vendors. We do not record video visits without your separate consent.
6. Limited diagnostic scope. Your clinician may identify a condition outside the scope of services Teledris Health provides and refer you elsewhere.
7. Continuity with other providers. Telehealth care may not be sufficient by itself, and we strongly encourage you to maintain a relationship with a primary care provider.

If you are in crisis, you may also contact the 988 Suicide and Crisis Lifeline by calling or texting 988.

By submitting an intake and being accepted for care, you and your treating clinician establish a provider–patient relationship through telehealth, consistent with the laws of your state of residence.

Your clinician may decline to establish a provider–patient relationship if your clinical situation is outside the scope of telehealth practice or outside Teledris Health's services. Because your card is only authorized (not charged) until a clinician approves treatment, if treatment is declined you are not charged, in accordance with our Refund Policy.

You agree to participate in monitoring and follow-up as directed by your clinician. This typically includes:

• Periodic check-ins through the Teledris Health platform.
• Reporting your progress on the cadence requested.
• Reporting side effects, new symptoms, and any new medications.
• Completing requested laboratory tests if ordered.
• Notifying us before any planned surgery or anesthesia.
• Notifying us if you become pregnant or are planning pregnancy.

Failure to participate in monitoring may result in pausing or stopping your treatment.

By accepting care through Teledris Health, you agree to:

• Provide accurate, complete, and current information at intake and at every follow-up.
• Notify us promptly of any new diagnosis, hospitalization, surgery, or new medication.
• Follow the dosing instructions provided by your clinician and the partner pharmacy.
• Store medication as directed and never share it with another person.
• Properly dispose of needles and unused medication.
• Use the Teledris Health platform for non-emergency communication only.
• Pay for services and medications as agreed.

The following addenda apply if you are a resident of, or are physically located in, the listed state at the time of your visit. State-specific telehealth law may impose additional requirements.

You have the right to withdraw your consent to telehealth or to a particular treatment at any time by notifying us in writing at support@teledris.com or through the platform.

Withdrawal of consent will not affect care already provided, and you may remain responsible for fees already incurred. Withdrawal will end any subscription on its next billing date in accordance with our Refund Policy.

By acknowledging this Consent electronically and proceeding to care, you confirm that:

1. You have read and understood this Consent.
2. You have had the opportunity to ask questions, and any questions have been or will be answered to your satisfaction by your clinician.
3. You voluntarily agree to receive care through telehealth and, if prescribed, to use medication as directed by your clinician.
4. You have disclosed accurate and complete medical information.
5. You understand the differences between compounded and branded medications.
6. You understand the risks and potential side effects of any medication prescribed to you.
7. You agree to participate in monitoring and follow-up.
8. You understand your right to withdraw consent at any time.

Questions about this Consent should be directed to:
Teledris Health
8 The Green, STE 12393, Dover, DE 19901
support@teledris.com

Privacy questions should be directed to privacy@teledris.com.