Telemedicine Consent

Telemedicine services may include, but are not limited to:

• •Medical history review and health questionnaires
• •Evaluation, assessment, and diagnosis
• •Treatment planning and follow-up care
• •Prescribing medications when medically appropriate
• •Education and counseling

Telemedicine services are provided using secure audio, video, and/or electronic communication technologies.

Dosely does not provide emergency or urgent medical services.

If you believe you are experiencing a medical emergency, you must call 911 or seek immediate care from the nearest emergency department. You should not rely on telehealth services for emergency situations.

Your participation in telemedicine is voluntary.

You understand that:

• •You may choose to seek in-person medical care instead of telemedicine
• •A provider may determine that telemedicine is not appropriate for your condition
• •A provider may recommend in-person evaluation, laboratory testing, imaging, or referral to another clinician

Potential benefits may include:

• •Improved access to care
• •Convenience and reduced travel
• •Timely evaluation and follow-up

You understand and acknowledge the potential risks of telemedicine, which may include:

• •Information transmitted may be less complete than in an in-person visit
• •Technical failures may delay or interrupt care
• •Limitations in physical examination may affect clinical decision-making
• •Despite reasonable safeguards, there is a risk of privacy or security breach

Telemedicine services often involve the electronic transmission of health information.

Dosely and its clinical partners take reasonable steps to protect the privacy and security of your information and comply with applicable healthcare privacy laws, including HIPAA, when required. Use and disclosure of Protected Health Information may be governed by a separate Notice of Privacy Practices, which will be made available to you when applicable.

You understand that:

• •Medical care is provided by licensed healthcare providers
• •All medical decisions are made by the provider based on professional judgment and applicable law
• •No diagnosis, treatment plan, or prescription is guaranteed

If a provider determines that medication is medically appropriate:

• •A prescription may be issued following a clinical evaluation
• •There is no guarantee that medication will be prescribed
• •Prescriptions are issued only in compliance with state and federal law

You may request that a prescription be sent to a pharmacy of your choice or elect fulfillment through a licensed partner pharmacy.

You represent and agree that:

• •You will be physically located in the state you report at the time of each telehealth visit
• •Telehealth services may be declined or rescheduled if you are not located in an eligible state
• •Availability of specific treatments may vary by state

You may withdraw your consent to receive telemedicine services at any time by discontinuing use of the platform or notifying Dosely. Withdrawal of consent will not affect your right to future care, but it may limit the manner in which services can be provided.

You understand and agree that:

• •Dosely does not accept insurance unless explicitly stated
• •You are responsible for payment of all fees disclosed prior to receiving services
• •Fees for telehealth services are due regardless of whether medication is prescribed

By proceeding with Dosely's telehealth services, you confirm that:

• •You have read and understand this Telemedicine Consent
• •You have had the opportunity to ask questions
• •All questions have been answered to your satisfaction
• •You voluntarily consent to receive healthcare services via telemedicine

If you have questions about telemedicine services or this consent, contact: