Consent to Telehealth Services Menspro Health

Menspro Health provides online access to licensed, independent health care professionals through secure technology platforms (the “Services”). Through these Services, you may complete a medical evaluation, consult with a licensed provider in your state, and, if medically appropriate, receive prescriptions and ongoing treatment.
These Services constitute telehealth.

Telehealth is the delivery of health care services using electronic communication when the provider and patient are not in the same physical location. Telehealth may be used for assessment, diagnosis, consultation, treatment, monitoring, follow-up care, patient education, and the transfer of medical data.

Telehealth does not include emergency services.

What Telehealth May Include
Telehealth services may involve:

• Electronic transmission of medical records, images, laboratory results, and personal health information
• Communication with a licensed provider via secure audio, video, or messaging technology
• Review of health questionnaires and medical history
• Remote monitoring data when applicable
• Coordination with a pharmacy for prescribed medications, if appropriate

Menspro Health uses commercially reasonable security protocols designed to protect the privacy and integrity of your health information.

Potential Benefits
Telehealth may:

• Provide more convenient access to care
• Reduce travel time and scheduling delays
• Allow timely follow-up and treatment adjustments
• Provide access to licensed providers in your state

A provider may evaluate you via telehealth and, if appropriate, may diagnose and treat you without conducting an in-person physical examination.

Potential Risks and Limitations
You understand that:

• Information shared electronically may be insufficient for appropriate medical decision-making
• Certain conditions may require an in-person evaluation or additional testing
• A provider may determine that telehealth is not appropriate for your condition
• Technical failures may disrupt or delay care
• Although safeguards are in place, electronic systems carry inherent privacy risks
• Regulatory requirements in your state may limit certain treatment options or prescriptions

The inability to perform a physical examination may limit the provider’s ability to fully assess your condition. In some cases, you may be directed to seek in-person care.
Telehealth is not appropriate for medical emergencies.

If you are experiencing chest pain, shortness of breath, severe symptoms, or any medical emergency, call 911 immediately or go to the nearest emergency room.

Acknowledgments and Agreement
By checking the “I Agree” box, you acknowledge and agree that:

• You understand you cannot obtain emergency care through the Services
• You understand that if you require emergency care, you must call 911 or seek immediate in-person treatment
• You voluntarily give informed consent to receive medical care and treatment through telehealth
• You understand that telehealth requires the formation of a doctor/patient relationship prior to care being provided and attest that such a relationship exists between yourself and your physician
• You understand telehealth is an evolving field and may involve technologies not specifically described here
• You understand technical issues may interrupt your visit or result in loss of information
• You understand that no medical outcome can be guaranteed
• You understand your condition may not improve and, in some cases, could worsen
• You agree to provide complete and accurate information regarding your health, medical history, medications, and symptoms
• You understand that providing inaccurate or incomplete information may result in harm
• You understand that your provider may determine telehealth is not appropriate and may require in-person care
• You understand that the Services supplement but do not replace your relationship with other health care providers
• You understand your information will be collected, used, and protected in accordance with the Menspro Health Privacy Policy
• You understand you may request that your telehealth records be shared with another health care provider in accordance with applicable law
• You understand you may withdraw this consent at any time by contacting Menspro Health in writing, and that consent will otherwise apply to each telehealth encounter

By selecting “I Agree,” you confirm that you have read this Consent to Telehealth, understand the risks and benefits, and authorize Menspro Health and its licensed providers to provide telehealth services and to collect, use, and disclose your health information as permitted by law for treatment, payment, and health care operations.