Telehealth Informed Consent

Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up, patient education, and consultation.

Through the Loop Health platform, telehealth consultations may be conducted via:

• Asynchronous (store-and-forward) communication, where you submit health information and a provider reviews it at a later time.
• Synchronous (real-time) video or audio consultations.
• Secure messaging between you and your provider.

Loop Health is a technology platform, not a healthcare provider. The licensed healthcare providers accessible through Loop Health are independent practitioners who are not employees, agents, or representatives of Loop Health. The provider-patient relationship is formed directly between you and the treating provider.

The provider will use their independent clinical judgment to evaluate your health information, determine whether telehealth is appropriate for your condition, and decide whether to prescribe treatment.

Potential benefits of telehealth include:

• Improved access to healthcare, especially for those in rural or underserved areas.
• Convenience of receiving care from your home or other location.
• Reduced travel time and associated costs.
• Timely access to clinical evaluation and follow-up.

Telehealth has potential risks and limitations, including but not limited to:

• The provider may not have access to your complete medical history.
• The inability to perform a physical examination may limit the provider's ability to diagnose or treat certain conditions.
• Technical difficulties (e.g., poor internet connection, equipment failure) may interrupt or prevent the consultation.
• Although security measures are in place, electronic communication carries inherent risks to privacy.
• In rare cases, the provider may determine that telehealth is not appropriate for your condition and may recommend in-person care.
• Delays in evaluation and treatment may occur due to technology failures.

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

• Withhold or withdraw your consent to telehealth services at any time without affecting your right to future care.
• Access your medical records related to telehealth consultations.
• Receive information about the provider's qualifications and licensure.
• Expect that your health information will be protected in accordance with HIPAA and applicable state laws.
• Request a referral to an in-person provider at any time.

By participating in telehealth services through Loop Health, you agree to:

• Provide accurate and complete health information, including medical history, current medications, allergies, and current symptoms.
• Inform the provider of any changes in your health status.
• Follow the treatment plan prescribed by the provider and report any adverse effects.
• Not record telehealth sessions without the prior consent of the provider.
• Be located in a state where the provider is licensed at the time of the consultation.
• Seek emergency care by calling 911 in case of a medical emergency. Telehealth is not a substitute for emergency care.

If your provider prescribes a compounded medication through the Loop Health platform, you acknowledge that:

• Compounded medications are not FDA-approved. They have not undergone FDA premarket review for safety, effectiveness, and quality.
• Compounding pharmacies are licensed and inspected by state Boards of Pharmacy.
• All compounds provided through Loop Health include third-party Certificates of Analysis (COAs).
• You should report any adverse effects to your provider and to the FDA MedWatch program.

Loop Health and its provider partners comply with HIPAA regulations to protect the privacy and security of your health information. Technical safeguards, including encryption and secure communication channels, are used to protect your data during telehealth consultations. For more information, see our Privacy Policy.

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

If you are experiencing a mental health crisis, please contact the 988 Suicide and Crisis Lifeline by calling or texting 988.

By proceeding with a telehealth consultation through Loop Health, you confirm that:

• You have read and understood this Telehealth Informed Consent.
• You understand the risks, benefits, and limitations of telehealth.
• You consent to receive telehealth services through the Loop Health platform.
• You understand that Loop Health is a technology platform and not a healthcare provider.
• You have had the opportunity to ask questions about telehealth.

If you have questions about this Consent or our telehealth services, please contact us:

Loop Health, LLC
Los Angeles, CA
support@loop.health