Telehealth Informed Consent

1. What Telehealth Is

Telehealth is the delivery of health care using electronic communications and information technology when you and your clinician are not in the same physical location. Through the Vivo platform, this generally means:

• Asynchronous (“store-and-forward”) care — you complete a written intake describing your health history, goals, medications, and symptoms. A licensed clinician reviews it at a later time and makes a clinical determination. In most cases there is no live video or phone visit.
• Synchronous care, if the clinician determines a live audio or video visit is necessary.
• Secure messaging for follow-up questions and reassessment.

2. Who Is Treating You

Your clinician is licensed in the state where you are located and is affiliated with Arora Health & Aesthetics, LLC, an independent professional entity. Your clinician may be a physician, nurse practitioner, or physician assistant, practicing within their license and scope in your state.

Your clinician may be physically located in a different state than you. Telehealth involves the electronic communication of your medical information to a clinician who may be located elsewhere, including out of state. What matters is that your clinician holds an active license in the state where you are located at the time of your evaluation.

You have the right to know who is treating you. Your clinician’s name and credentials are recorded in your medical record and are available to you on request.

Vivo Health LLC does not provide medical care. Vivo operates the technology and administrative services. Vivo has no role in and no authority over any clinical decision about you. Your clinician exercises independent professional judgment.

Medication, if prescribed, is compounded and dispensed by VialsRX (the “Pharmacy”), an independent state-licensed 503A compounding pharmacy.

3. Benefits of Telehealth

• Access to a licensed clinician without travel or a waiting room;
• Faster and more flexible evaluation;
• Care that fits a working schedule.

You may expect these benefits, but no result can be guaranteed or assured.

4. Risks and Limitations of Telehealth — Please Read Carefully

Telehealth is not equivalent to an in-person examination. By consenting, you acknowledge and accept the following:

• No physical examination. Your clinician cannot palpate, auscultate, inspect, or otherwise physically examine you. Conditions that would be detected on physical exam may be missed.
• The evaluation depends entirely on the accuracy of what you report. Your clinician does not have access to your complete medical records. Incomplete, inaccurate, or withheld information — including other medications, supplements, allergies, or conditions — may lead to an incorrect determination, an unsafe recommendation, an adverse drug interaction, or an allergic reaction. This is the single largest risk in asynchronous care.
• Delays. Asynchronous review is not immediate. Responses may be delayed by clinician availability, technical issues, or requests for additional information.
• Technology failure. Transmission may fail, be delayed, or be of insufficient quality to support a determination.
• Security. Although we use encryption and reasonable safeguards, no electronic transmission is perfectly secure. There is a residual risk of unauthorized access.
• Escalation may be required. Your clinician may determine that telehealth is not appropriate for you and may decline to prescribe and refer you for in-person evaluation. This is a valid and expected outcome.
• Not all conditions are appropriate for telehealth. Some require in-person care.

The care you receive is at the sole discretion of the clinician treating you, with no guarantee of evaluation, treatment, or prescription. Your clinician determines whether your situation is appropriate for asynchronous telehealth at all.

5. This Service Is Not for Emergencies

If you are experiencing a medical emergency — including chest pain, difficulty breathing, severe allergic reaction, thoughts of harming yourself or others, or any other urgent condition — call 911 or go to the nearest emergency department immediately.

Do not use the Vivo platform, secure messaging, or email to report an emergency. Messages are not monitored 24/7, there is no on-call service, and no one is watching for an urgent message from you.

6. Compounded Medications

You understand and acknowledge that any medication prescribed to you through this service may be a compounded preparation, and that:

• Compounded medications are prepared by a licensed 503A pharmacy for a specific patient pursuant to a prescription;
• Compounded medications are not approved by the FDA. The FDA does not evaluate compounded preparations for safety, effectiveness, or manufacturing quality before they are marketed;
• Compounded preparations may differ from commercially available products;
• Individual results vary, and no outcome is guaranteed.

You have had the opportunity to ask questions about compounded medications and to decline treatment.

7. Your Rights

• Consent is voluntary. You may refuse telehealth and seek in-person care at any time.
• You may withdraw consent at any time, without affecting your right to future care. Withdrawal is effective going forward and does not undo care already provided. To withdraw consent, email care@vivoclinic.org.
• You have the right to ask questions and to have them answered before proceeding.
• You have the right to know who is treating you and to be informed of alternatives, including in-person evaluation and no treatment at all.
• You have the same privacy rights in a telehealth encounter that you would have in an in-person visit.
• Your information is protected. See the Notice of Privacy Practices.

8. Privacy, Records, and Limits on Confidentiality

A record of your telehealth encounter is created and maintained by the Medical Group as part of your medical record, subject to state retention requirements. You may request access as described in the Notice of Privacy Practices. No recording of any visit will be made without your express consent.

Identifiable images or information from your encounter will not be disclosed to researchers or any other entity without your written authorization.

Confidentiality has limits. Your health information may be disclosed without your authorization in circumstances permitted or required by law and by the regulations of the state where you are located, including:

• In response to a valid court order or subpoena for medical records;
• To report suspected abuse, neglect, or domestic violence, where a clinician is required by law to do so;
• To prevent or lessen a serious and imminent threat to the health or safety of you or another person.

The full list is described in the Notice of Privacy Practices.

9. Consent to Calls and Text Messages

This consent is not a condition of purchase. You can obtain care and buy medication without agreeing to it, and you can withdraw it at any time without affecting your treatment.

If you provide your mobile number and opt in, you consent to receive calls and text messages (SMS and MMS) from Vivo Health LLC, the Medical Group, and the Pharmacy at that number — including messages sent using an automatic telephone dialing system and messages using an artificial or pre-recorded voice, even if your number is on a do-not-call list. These may include:

• Care and clinical messages: requests for information from your clinician, reassessment reminders, and prescription updates.
• Transactional messages: order confirmations, shipping and delivery notices, refill timing, and billing or account alerts.
• Marketing messages, only if you separately opt in: new protocols, offers, and promotions.

Message frequency varies. Message and data rates may apply. Neither Vivo Health LLC nor any wireless carrier is liable for delayed or undelivered messages.

How to stop. Reply STOP to any message to unsubscribe from that message type; we may send one final message confirming the opt-out. Reply HELP for assistance, or contact care@vivoclinic.org. If you are enrolled in more than one message type, you must opt out of each. Opting out of marketing messages does not stop transactional or care messages while you have an active order or subscription — those are part of the service.

Text and voice messages are not encrypted and may be intercepted or seen by anyone with access to your device. A message may reveal that you are a patient. If you would rather not receive health information this way, do not opt in, or use secure messaging inside your account instead.

This consent is tied to the number you provide. Tell us if that number changes or is reassigned to someone else — contact care@vivoclinic.org.

10. Payment

Telehealth services are self-pay. Insurance is not billed. You are responsible for the charges disclosed at checkout. Payment does not guarantee a prescription. If a clinician determines treatment is not appropriate, refer to the Refund Policy — you receive a full refund.

11. Prescription Continuity

A prescription is valid for a limited period. Continued therapy requires periodic reassessment by a clinician on a cadence determined by clinical judgment and applicable law. A subscription does not extend a prescription. If you do not complete a required reassessment, refills will stop.

12. Location Requirement

You must be physically located in a state where your clinician is licensed at the time of your evaluation and at the time of each reassessment. You agree to accurately report your location and to notify us if you move. Providing a false location may invalidate the encounter and the prescription.

13. Duration and Re-Consent

This consent applies to your telehealth encounters with the Medical Group until you withdraw it. If this form is materially revised, you will be asked to review and consent to the current version before your next evaluation. The version in effect at the time of each encounter is the version that governs it.

14. Acknowledgment and Consent

Consent is given inside the intake, where each attestation below is recorded as an affirmative, timestamped action alongside the version of this form in effect at that time. This page publishes the form text; it does not collect consent. When you proceed through intake, you attest that:

• You have read and understood this Telehealth Informed Consent.
• You have had the opportunity to ask questions, and any questions you asked were answered to your satisfaction.
• You understand the benefits, risks, and limitations of telehealth, including that no physical examination will be performed.
• You understand that the evaluation depends on the accuracy of the information you provide, and you attest that the information you have provided is true, complete, and current.
• You understand that payment does not guarantee a prescription, and that a clinician may decline to prescribe.
• You understand that any medication prescribed may be a compounded preparation that is not FDA-approved.
• You understand that Vivo Health LLC does not provide medical care and that your clinician is an independent professional affiliated with Arora Health & Aesthetics, LLC.
• You understand this service is not for emergencies and that messages are not monitored 24/7.
• You are 18 years of age or older and are seeking care for yourself.
• You are physically located in the state you have reported.
• You voluntarily consent to receive telehealth services from Arora Health & Aesthetics, LLC.

Separately, and optionally, you may consent to receive calls and text messages as described in Section 9. That consent is captured as its own affirmative action, is not required to receive care or purchase medication, and may be declined or withdrawn at any time without affecting your treatment.

Vivo Health LLC
721 East Broadway, Suite A
Glendale, CA 91205, United States
care@vivoclinic.org · +1 (762) 327-2774