Telehealth Informed Consent

Introduction

This Telehealth Informed Consent ("Consent") describes the nature of telehealth services provided through Amplify Health's platform at amplifyhealth.com. By proceeding with a consultation or enrolling in a program, you acknowledge that you have read, understood, and agreed to the terms of this Consent.

What Is Telehealth?

Telehealth is the delivery of healthcare services using electronic communications, including live video consultations, secure messaging, and electronic transmission of health data. Through Amplify Health's platform, you will have access to independent licensed physicians who will review your lab results and health history, conduct consultations, and, where clinically appropriate, prescribe compounded medications dispensed by our pharmacy partner.

Telehealth is not the same as in-person care. Your physician will not conduct a physical examination in person.

Physician Information

Amplify Health partners with a network of independent licensed physicians. Each physician is licensed in the state(s) where they practice. You have the right to know the name, credentials, and licensing information of the physician assigned to your care. This information will be provided during your consultation or upon request.

The physicians on our platform are independent practitioners. Amplify Health does not own or operate a medical practice.

Program Structure

Depending on the program and your clinical profile:

• Some programs require a live video consultation with a licensed physician before any prescription is issued
• Some programs may not require a live consult; based on qualifying clinical factors, your physician may review your intake and lab results asynchronously and send a prescription directly to a licensed pharmacy in our network
• All prescriptions are issued at the physician's sole clinical discretion, regardless of the consultation format

Benefits of Telehealth

• Convenient access to licensed physicians from anywhere in your state
• Ongoing monitoring and protocol adjustments through regular clinical evaluations
• Discreet, private care experience
• Access to specialized programs in hormone optimization, weight loss, sexual enhancement, and longevity

Risks and Limitations of Telehealth

You acknowledge the following risks and limitations:

• Technology failures: Electronic communications may experience interruptions or failures affecting service delivery
• No physical examination: Your physician cannot conduct a hands-on physical exam, which may limit assessment of certain conditions
• Information security risks: Although we use secure, encrypted systems, no internet transmission is completely secure
• Clinical limitations: Not all conditions are appropriate for telehealth management. Your physician may determine that an in-person visit or specialist referral is necessary
• Prescription limitations: Physicians may not prescribe certain medications via telehealth under applicable laws or clinical judgment. No prescription is guaranteed
• Emergency situations: Telehealth is not appropriate for emergencies. In a medical emergency, call 911 or go to the nearest emergency room

Your Responsibilities

By consenting, you agree to:

• Provide complete, accurate, and honest health and medical information
• Disclose all current medications, supplements, vitamins, and over-the-counter drugs
• Disclose all known allergies and prior adverse reactions to medications
• Complete any required lab testing prior to or as directed by your physician
• Maintain a relationship with a primary care provider for general health needs
• Promptly report any adverse reactions or unexpected side effects to our clinical team
• Not share your prescription medications with others
• Contact emergency services (911) in any medical emergency

Privacy and Security

Your health information is protected under HIPAA and applicable state privacy laws. We use secure, encrypted systems to transmit and store your information. Amplify Health maintains LegitScript certification reflecting our commitment to legal and ethical telehealth standards.

For more information, please see our HIPAA Notice of Privacy Practices and Privacy Policy.

Compounded Medications and Pharmacy Partner

You acknowledge and understand that:

• Medications prescribed through Amplify Health are compounded preparations dispensed by licensed compounding pharmacies in our network
• Compounded medications are not FDA-approved drugs and have not undergone FDA review for safety, efficacy, or quality as finished drug products
• Compounded medications are legal under federal law when prescribed by a licensed physician for an identified patient
• Results may vary; no specific outcome is guaranteed
• You will be informed of active ingredients, dosage, and administration method for any prescribed medication

State-Specific Disclosures

• California: [State-specific telehealth disclosure requirements]
• Florida: [Provider credential disclosure requirements]
• New York: [State telehealth consent requirements]
• Texas: [Applicable disclosures]

Withdrawal of Consent

You may withdraw this consent at any time by contacting us in writing at hello@amplifyhealth.com. Withdrawal will not affect services already rendered or prescriptions already filled. If you withdraw consent, we may be unable to continue providing telehealth services to you.

Acknowledgment

By proceeding, you confirm that:

1. You have read and understood this Telehealth Informed Consent
2. You have had the opportunity to ask questions
3. You voluntarily consent to receive healthcare services via telehealth through Amplify Health's platform
4. You understand the benefits, risks, and limitations described above
5. You are at least 18 years of age and legally capable of providing this consent

Contact

Amplify Health. Email: hello@amplifyhealth.com

In a medical emergency, call 911 or go to your nearest emergency room.