Telehealth Consent

This Telehealth Consent ("Consent") describes your rights, responsibilities, and limitations associated with receiving healthcare services through Eleva MD ("Eleva MD," "we," "our," or "us") via telehealth technologies. By accessing or using Eleva MD's telehealth services, you acknowledge that you have read, understand, and voluntarily agree to this Consent.

1. What Is Telehealth

Telehealth involves the delivery of healthcare services using electronic communications, including secure messaging, online questionnaires, digital health records, and other remote technologies. Through telehealth, licensed physicians may evaluate your health information, determine eligibility for treatment, provide medical guidance, prescribe medications when clinically appropriate, and communicate with you without an in-person visit.

2. Nature of the Physician–Patient Relationship

When you engage in telehealth services through Eleva MD, a physician–patient relationship may be established if a licensed physician accepts your case for care. All medical decisions are made by licensed physicians in accordance with applicable state and federal laws. Eleva MD does not guarantee approval for treatment or the issuance of any prescription.

3. Benefits of Telehealth

Potential benefits of telehealth include:

• Access to licensed physicians without the need for in-person visits
• Timely clinical evaluation and follow-up
• Convenience and continuity of care
• Privacy and discretion

4. Risks & Limitations of Telehealth

You understand and acknowledge that telehealth has inherent limitations, including:

• Inability to perform physical examinations
• Potential for incomplete or inaccurate information if disclosures are incomplete
• Technical failures or connectivity issues
• Situations where in-person care may be clinically necessary

A physician may determine that telehealth is not appropriate for your condition and may decline or discontinue care accordingly.

5. No Emergency Care

6. Patient Responsibilities

You agree to:

• Provide accurate, complete, and truthful medical information
• Disclose relevant symptoms, conditions, medications, and allergies
• Update your information as your health status changes
• Follow prescribed treatment plans and physician instructions

You understand that inaccurate or incomplete information may result in clinical risk, denial of care, or discontinuation of services.

7. Communication & Messaging

Eleva MD provides secure portal-based messaging as part of telehealth care. You understand that messaging is intended for non-emergency communication only, messages are not monitored continuously or in real time, and response times are not guaranteed. You agree not to use messaging for urgent or emergency medical concerns.

8. States Served

Eleva MD currently provides telehealth services to patients located in states where its affiliated licensed physicians are authorized to practice. Services may not be available in all states and are subject to change as licensing and regulatory requirements evolve. By initiating an intake, you represent that you are located in a state where Eleva MD operates at the time services are rendered. If you relocate to a state where services are not available, you agree to notify us promptly. Availability of specific treatments may vary by state based on applicable law.

9. Right to Withdraw Consent

You have the right to withdraw this Consent and discontinue telehealth services at any time, without penalty or loss of access to other medical care. To withdraw consent, contact Eleva MD support at support@eleva.md. Withdrawal of consent will not affect the validity of treatment already rendered. If you withdraw consent while under active treatment, your physician will discuss appropriate steps for continuity or transition of care.

Eleva MD or its affiliated physicians also reserve the right to discontinue telehealth services at their discretion, including if telehealth is determined to be clinically inappropriate, if you provide inaccurate or incomplete information, or if continued care would be inconsistent with applicable law or clinical standards.

10. Electronic Consent

By proceeding with Eleva MD's telehealth services — including completing the online health intake form, submitting your information, or initiating a patient encounter — you confirm that:

• You have read and understand this Telehealth Consent in its entirety
• You are 18 years of age or older
• You have the legal capacity to enter into this Consent
• You voluntarily and knowingly agree to receive healthcare services via telehealth under these terms
• You understand that your electronic action constitutes your legally binding signature

Pursuant to the Electronic Signatures in Global and National Commerce Act (E-SIGN Act) and applicable state e-signature laws, your electronic agreement is legally equivalent to a handwritten signature. You acknowledge that electronic records and signatures are valid and enforceable.

11. Privacy & HIPAA

Your health information is handled in accordance with our HIPAA Notice of Privacy Practices and our Privacy Policy. Protected health information collected during telehealth services is used only for treatment, payment, and healthcare operations, and is shared only as permitted by law.

12. Contact & Questions

If you have questions about this Consent, your rights, or Eleva MD's telehealth services, please contact:

• Email: support@eleva.md
• Website: eleva.md/contact