Telehealth Informed Consent

This Telehealth Informed Consent ("Consent") describes the nature, benefits, risks, and limitations of telehealth services provided through Revela.care. Please read this document carefully. By using Revela's telehealth Services, you acknowledge that you have read, understood, and voluntarily consent to the terms described herein.

1. What Is Telehealth?

Telehealth refers to the delivery of healthcare services using electronic communications technology, including video, audio, and secure asynchronous messaging, to enable interaction between patients and licensed healthcare providers when they are not in the same physical location. Through Revela.care, you may interact with licensed physicians, nurse practitioners, physician assistants, or other healthcare professionals via synchronous video consultations or asynchronous intake questionnaires, as appropriate for your care.

2. Benefits of Telehealth

Telehealth offers several advantages over traditional in-person care, including:

• Convenient access to licensed providers from your home or any private location.

• Reduced time and cost associated with travel and in-person appointments.

• Access to specialized care that may not be available in your geographic area.

• Continuity of care through ongoing provider relationships and digital communication.

• Faster access to clinician-guided wellness evaluations and, where appropriate, prescription therapies.

3. Limitations and Risks of Telehealth

You acknowledge that telehealth services have inherent limitations, including:

• Physical Examination: Your Provider cannot perform a physical examination through a telehealth encounter. Certain conditions may require in-person evaluation, laboratory testing, imaging, or other diagnostic procedures that cannot be performed remotely.

• Clinical Appropriateness: Not all conditions can be appropriately diagnosed or treated via telehealth. Your Provider may determine that an in-person visit is necessary and may decline to provide treatment via telehealth.

• Technology Failures: Telehealth relies on electronic communication technology that may fail, resulting in incomplete consultations, disrupted video or audio, or data transmission errors. In the event of a technical failure, your Provider will make reasonable efforts to reschedule or continue your consultation.

• Privacy Risks: While Revela employs robust security measures, electronic communication carries inherent risks of interception or unauthorized access. Please ensure you are in a private location when participating in a telehealth consultation.

• Compounded Medications: If your Provider prescribes a compounded medication, you understand that compounded preparations are not FDA-approved and are customized formulations. The safety, efficacy, and quality of compounded medications may differ from commercially available FDA-approved products.

4. Emergency Situations

Telehealth services are not appropriate for medical emergencies. If you experience a medical emergency—including chest pain, difficulty breathing, severe allergic reaction, stroke symptoms, loss of consciousness, or any other life-threatening condition—call 911 immediately or go to the nearest emergency room. Do not attempt to reach Revela or your Provider during a medical emergency.

At the start of your consultation, your Provider may ask for your current physical location so that emergency services can be dispatched to you if necessary.

5. Privacy and Confidentiality

Your health information shared during telehealth consultations is subject to federal and state privacy laws, including HIPAA. Your information will not be disclosed without your consent except as required or permitted by law. Please refer to our HIPAA Notice of Privacy Practices and Privacy Policy for full details on how your information is used and protected.

To protect your privacy, we recommend that you: (a) use a secure, private Wi-Fi connection; (b) conduct your consultation in a private location where you cannot be overheard; and (c) use a personally-owned device with up-to-date security software.

6. Prescription and Medication Consent

If your Provider determines that medication is clinically appropriate, you consent to the Provider issuing a prescription and transmitting that prescription to a licensed compounding pharmacy on your behalf. You understand that:

• Prescribing is at the sole discretion of your Provider. No prescription is guaranteed.

• You will review all medication information, including directions for use, potential side effects, and contraindications, prior to use.

• You will inform your Provider of all current medications, supplements, and health conditions to avoid potential drug interactions.

• You will promptly report any adverse reactions or concerns to your Provider.

7. Your Responsibilities

By using Revela's telehealth Services, you agree to:

• Provide complete, accurate, and truthful information about your health history, medications, and symptoms.

• Inform your Provider of any changes in your health status.

• Follow your Provider's recommendations and instructions, or inform your Provider if you do not intend to do so.

• Maintain a primary care provider for general health needs and coordinate your Revela care with your other healthcare providers.

• Seek emergency care when needed and not rely on Revela for emergency medical situations.

8. Voluntary Participation and Right to Withdraw

Your participation in telehealth services through Revela is entirely voluntary. You have the right to refuse any aspect of the consultation or any recommended treatment. You may discontinue your use of our Services at any time without penalty. Discontinuing Services may, however, affect your ongoing treatment plan, and you are encouraged to discuss any concerns with your Provider before discontinuing care.

9. Multi-State Availability

Revela operates across all 50 U.S. states through a network of licensed healthcare providers. Telehealth laws and regulations vary by state, and the scope of services available to you may be subject to the laws of the state where you are physically located at the time of your consultation. By using our Services, you represent that you are physically located in a state where Revela is authorized to provide services.

10. Acknowledgment and Consent

By completing our online intake process and proceeding with a telehealth consultation, you acknowledge that:

• You have read and understood this Telehealth Informed Consent.

• You understand the nature, benefits, risks, and limitations of telehealth services as described herein.

• You voluntarily consent to receive telehealth services through Revela.care.

• You understand that you may withdraw this consent at any time.

• You have had the opportunity to ask questions and have had those questions answered to your satisfaction.