Telehealth Informed Consent

Required by law before any telehealth service. Clinical services are provided through licensed providers on the MyOrbit Health platform in partnership with The Original Peptide Fairy.

1. Risks & Benefits

Telehealth is the delivery of healthcare services using electronic communications between a provider and a patient who are not in the same physical location. Your program uses one of two visit types:

• Synchronous (live video): a real-time interactive visit with your provider via secure video.
• Asynchronous (store-and-forward): you complete a detailed health questionnaire; your provider reviews your information and responds with a clinical assessment and treatment recommendation. You are not present in real time during the review.

Benefits of telehealth include:

• Access to licensed provider care without travel to a physical office
• Convenient scheduling from your home or private location
• Faster access to evaluation and treatment
• Secure ongoing communication with your care team

Risks and limitations include:

• Your provider cannot physically examine you. Some conditions may require an in-person evaluation before a prescription can be issued.
• Your provider may determine at any time that a program or medication is not appropriate for you based on the information available via telehealth.

2. Technology Limitations

Technology failures may interrupt a visit; your provider will attempt to reconnect or contact you by phone. Transmission of health information over electronic networks carries inherent security risks despite the security measures in place. You are responsible for maintaining a compatible device, reliable internet connectivity, and a private location for health discussions.

3. Emergency Situations

Telehealth is not appropriate for emergencies. Call 911 immediately if an emergency develops, or go to your nearest emergency room.

4. Provider Credentials

• All providers delivering services through the MyOrbit Health platform hold valid, current licenses in the states where they practice.
• You have the right to know the identity, credentials, and license number of your treating provider, available in your patient portal and upon request before your visit.
• You have the right to receive care in person from a provider of your choice instead of or in addition to telehealth.

5. Patient Responsibilities

• Provide accurate, complete, and current health information during intake and throughout your care.
• Verify your identity and confirm your physical location at the time of your visit.
• Notify your care team before your visit if you are located in a state where your treating provider is not licensed.
• Report side effects, new symptoms, or changes in your health to your provider promptly.

6. Consent Acknowledgment