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Consent to Telehealth

Last revised: September 26, 2024

**BY CLICKING "I AGREE," CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE "I AGREE" BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.

IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION SUCH AS CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988.

The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare services to you by independent, licensed healthcare professionals (a "Provider") (collectively, the "Services") using the online platform provided by ReflexMD, Inc. The Services constitute a form of telehealth, which involves the delivery of health care services using electronic communications between a health care provider and a patient who are not in the same physical location. Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. Always discuss alternative options with your Provider.

Telehealth may be used for diagnosis, treatment, follow-up and/or patient education. Telehealth may include, but is not limited to:

  • Electronic transmission of medical records, photo images, personal health information or other data between a patient and a Provider;
  • Interactions between a patient and a Provider via audio, video and/or asynchronous data communications, such as secure messaging and email; and
  • Use of data from remote monitoring devices, medical devices, and sound or video files.

The website and information systems used in the Services incorporate network and software security protocols to protect the privacy, security, and integrity of your health information.

Possible Benefits of Telehealth

  • Telehealth can make accessing medical care easier, more efficient, and less expensive.
  • You can obtain medical care and treatment at times that are convenient for you.
  • You can interact with providers without the necessity of an in-office appointment.

Possible Limitations and Risks of Telehealth

  • Information transmitted to your Provider may not be sufficient to allow for appropriate medical decision making or your Provider may not be able to provide medical treatment for your condition via telehealth, and you may be required to seek alternative care.
  • The inability of your Provider to conduct certain tests or assess vital signs in person may in some cases prevent the Provider from diagnosing or treating you or identifying that you need urgent medical care.
  • Your medical care could be delayed due to technological failures that interrupt the Services.
  • Data security protocols or safeguards could fail and cause a breach of your identified health information.
  • Due to the nature of the Services and regulatory requirements in certain jurisdictions, your treatment options, especially pertaining to certain prescriptions, may be limited.
  • Technology, including the Service, may contain bugs or other errors, which may limit functionality, produce erroneous results, render part or all of the Service unavailable or inoperable, or cause records, transmissions, data or content to be corrupted or lost.
  • The quality, accuracy or effectiveness of the services you receive from your Provider could be limited by the use of telehealth.
  • Your condition may not be cured or improved, and in some cases, may get worse.

Emergency Situations

If you are experiencing a life-threatening emergency, call 911 immediately or go to the nearest emergency room. Do not attempt to use the Services for emergency medical needs. If you require immediate or urgent care, you must seek care at an emergency room facility or other provider equipped to deliver urgent or emergent care.

If you are not experiencing an emergency but need prompt attention, you can communicate with Providers through the secure message service. If a technical failure prevents you from communicating with your Providers, please contact our support team at help@reflexmd.com.

Data Privacy and Protection

The electronic systems used in the Services incorporate network and software security protocols to protect the privacy and security of your information and include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your consent, except as authorized by law for the purposes of consultation, treatment, payment/billing, certain administrative purposes, and as otherwise required by law.

Use of the Services may include email communications to and from you that may include your protected health information. You understand that we do not and cannot guarantee the security or privacy of the services you use to receive communications, including for example your email service provider.

Your Acknowledgments

By accepting this Consent to Telehealth, you acknowledge your understanding and agreement to the following:

1. I have read this Consent to Telehealth carefully, and understand the risks and benefits of the use of telehealth in my medical care and treatment.

2. I give my informed consent to receive medical care and treatment by telehealth from Providers affiliated with ReflexMD.

3. I understand that the delivery of health care services via telehealth is an evolving field and that the use of telehealth in my medical care and treatment may include uses of technology not specifically described in this consent.

4. I understand that while the use of telehealth may provide potential benefits to me, as with any medical care service no such benefits or specific results can be guaranteed. My condition may not be cured or improved, and in some cases, may get worse.

5. I understand that I have a duty to answer questions about my health and medical history honestly and accurately, and to keep all of my health care providers, including my Provider, up-to-date on any changes in my health, symptoms, treatments, or medications.

6. I understand that withholding or providing inaccurate information about my health and medical history in order to obtain treatment may result in harm to me, including, in some cases, death.

7. I understand that my Provider may determine in his or her sole discretion that my condition is not suitable for treatment using telehealth, and that I may need to seek medical care and treatment in-person or from an alternative source.

8. I understand that the Services enable coordination and communication with a Provider and do not replace my relationship with any existing health care provider.

9. I understand that I cannot obtain emergency care through the Services, and I should call 9-1-1 and seek immediate medical treatment if I am experiencing a medical emergency.

10. I understand that my information, including my identified health information, will be collected, used, shared, and protected as described in the Privacy Policy.

11. I understand that I have access to all of my health and wellness information pertaining to my telehealth consultation with my Provider in accordance with applicable laws and regulations.

12. I understand that ReflexMD and my Provider will share my telehealth record with my other health care providers only with my consent and at my request. I understand that I can have my telehealth record sent to my other health care providers by emailing ReflexMD at help@reflexmd.com and providing my consent along with my health care provider's name, address, and phone number.

13. I understand that a technical failure affecting the Services may result in the loss of my information and/or interrupt my online visit. In addition to any disclaimers that I agreed to by accepting the Terms of Use, I agree to hold ReflexMD harmless for any loss of information or delay in care resulting from a technical failure.

Withdrawal of Consent

I understand that I can withhold or withdraw this consent at any time by emailing ReflexMD at help@reflexmd.com with such instruction. Any withdrawal of consent will be effective upon receipt of written notice, except that such withdrawal will not have any effect on any action taken by ReflexMD or my Provider(s) in reliance on this Consent before receipt of the written notice of withdrawal. Any withdrawal of consent will not affect any other provision of this Consent. Otherwise, this consent will be considered renewed upon each new telehealth consultation with a Provider.

State-Specific Information

If you have a concern about a medical professional, you may contact the Medical Board in your state regarding your concerns. For applicable contact information see the list available here.

Additional State-Specific Consents: The following consents apply to patients accessing ReflexMD’s website for the purposes of participating in a telehealth consultation as required by the states listed below:

Alaska: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

California: The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov . Physicians are licensed and regulated by the Medical Board of California. To confirm a license or file a complaint, go to www.mbc.ca.gov or call +1(800) 633-2322

Florida: I have received a copy of the Florida Weight Loss Consumer Bill of Rights, as set forth below:

Warning:

  • Rapid weight loss may cause serious health problems. Rapid weight loss is weight loss of more than 1 ½ pounds to 2 pounds per week or weight loss of more than 1 percent of body weight per week after the second week of participation in a weight-loss program.
  • Consult your personal physician before starting any weight-loss program.
  • Only permanent lifestyle changes, such as making healthful food choices and increasing physical activity, promote long-term weight loss.
  • Qualifications of your weight loss provider are available upon request.

You have a right to:

  1. Ask questions about the potential health risks of this program and its nutritional content, psychological support, and educational components.
  2. Receive an itemized statement of the actual or estimated price of the weight-loss program, including extra products, services, supplements, examinations, and laboratory tests.
  3. Know the actual or estimated duration of the program.

  4. Know the name, address, and qualifications of the person who has reviewed and approved the weight loss program according to section 468.505(1)(j), Florida Statutes.

    I have been informed that if I want to check the licensing details for a provider I can visit the Florida Department of Health’s website, here

Iowa: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Idaho: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Indiana: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Kentucky: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Maine: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Maine Board of Osteopathic Licensure’s website, here.

Oklahoma: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Oklahoma Board of Osteopathic Examiners’ website, here.

Oregon: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here.

Rhode Island: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Texas: I have been informed of the following notice:
NOTICE CONCERNING COMPLAINTS -Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: +1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us. AVISO SOBRE LAS QUEJAS- Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: +1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us

Vermont: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Vermont Board of Osteopathic Examiners’ website, here.

All capitalized terms used in this Consent to Telehealth but not defined herein have the meanings assigned to them in the Terms of Use. For avoidance of any doubt, the terms "ReflexMD", "we", "us", or "our" refer to ReflexMD Inc. and the terms "you" and "yours" refer to the person using the Services.