Telehealth Consent

Purpose of this consent

This consent explains telehealth and requests your authorization to receive healthcare fromthe independent medical group responsible for your care and its licensed healthcare professionals (collectively, the "Provider") using technology facilitated by SYN Now. Your Provider is responsible for clinical care and exercises independent professional judgment. SYN Now provides non-clinical technology and administrative support and does not practice medicine.

Nature of telehealth

Telehealth allows a Provider and patient in different locations to exchange medical information and deliver care. Your encounter may use an online questionnaire, photographs, records, secure or standard messaging, telephone, live audio or video, and store-and-forward technology. The Provider may review your health history, evaluate whether telehealth is appropriate, make an assessment, discuss treatment options, prescribe when clinically and legally appropriate, and provide follow-up instructions.

The Provider's name, credentials, professional entity, and applicable licensure information will be made available in connection with your care. You must be physically located in a state or jurisdiction where the Provider is authorized to practice at the time of the encounter.

Potential benefits

• greater convenience and access to licensed healthcare professionals;
• more efficient exchange of records and health information;
• care without traveling to a clinic when telehealth is appropriate; and
• ongoing communication and follow-up through available remote tools.

Potential risks and limitations

Telehealth may involve risks and limitations, including:

• the Provider may not be able to conduct a physical examination or observe information available during an in-person visit;
• photographs, records, or questionnaire answers may be incomplete, inaccurate, delayed, or insufficient;
• technical failures may interrupt or delay evaluation or communication;
• electronic communications may involve privacy or security risks despite reasonable safeguards;
• a condition may be misdiagnosed or not identified, or treatment may be delayed;
• medication can cause side effects, allergic reactions, interactions, or other complications; and
• care may need to be completed in person, through testing, or by another clinician.

The Provider may stop a telehealth encounter or decline treatment if the available technology or information is inadequate, telehealth is inappropriate, or applicable law requires a different form of care. No result is guaranteed.

Alternatives

Alternatives may include an in-person visit with a primary-care clinician or specialist, urgent care, a retail pharmacy, or choosing not to receive care. You may request information about alternatives and may decline telehealth without losing the right to seek care elsewhere.

Your responsibilities

By using telehealth, you agree to:

• provide complete and truthful identity, location, contact, medical, medication, allergy, and pregnancy information;
• tell the Provider when information or your health changes;
• participate from a reasonably private location and protect account credentials;
• follow the treatment plan, pharmacy label, monitoring, and follow-up instructions;
• ask questions when information is unclear and report side effects promptly; and
• seek in-person or emergency care when directed or when symptoms require it.

Prescriptions and pharmacy services

A prescription is never guaranteed. A Provider will prescribe only when the Provider determines it is clinically appropriate and permitted by law. Prescriptions may be sent to an independent licensed pharmacy. Some prescribed products may be compounded for an individual patient. Compounded medications are not FDA-approved, and FDA does not review their safety, effectiveness, or quality before marketing. The dispensing pharmacy's label and your Provider's instructions control how you should use medication.

Privacy, participants, and records

Laws protecting medical information apply to telehealth. Information may be used and disclosed for treatment, payment, healthcare operations, and other purposes permitted or required by law, as described in the applicable Notice of Privacy Practices. People may be present at the Provider's location for care, training, interpretation, or technical assistance; you may ask who is present and request that nonessential people leave.

The Provider will create and retain a medical record as required by law. You may request access to or a copy of the record, subject to applicable limits and reasonable fees. With authorization or as otherwise permitted by law, information may be shared with another clinician to coordinate care.

Technical failures and follow-up

If a connection fails or you do not receive an expected response, contact support at support@synnow.com. Do not wait for an online response if symptoms are urgent. SYN Now is not a replacement for a primary-care relationship, and you remain responsible for recommended in-person care, testing, and follow-up.

Fees and financial relationships

You are responsible for fees disclosed before purchase. Unless expressly stated otherwise, telehealth services and medication are cash-pay and claims are not submitted to insurance or government healthcare programs. Providers, pharmacies, and SYN Now may have contractual financial relationships related to the Services. You remain free to obtain care or fill a prescription elsewhere, subject to applicable prescription-transfer and pharmacy rules.

Electronic communications

You authorize the Provider and service teams to communicate with you using the email address, telephone number, text-messaging number, and patient portal you provide. Standard email, voicemail, and text may not be encrypted and may be seen by someone with access to your device or account. You accept these risks for service-related communications and may request reasonable communication alternatives.

Right to withdraw

You may withhold or withdraw consent to telehealth at any time by telling the Provider or contacting support@synnow.com. Withdrawal will not affect care already provided or records already created, but it may prevent continued treatment through the Services. State-specific notices presented during intake supplement this consent and control if they conflict with it.

Acknowledgment and electronic signature

By selecting an acceptance box, signing electronically, or proceeding after this consent is presented, you acknowledge that you have read and understand it, have had an opportunity to ask questions, consent to telehealth, and intend your electronic action to serve as your signature.