Effective Date: July 6, 2026
INFORMED CONSENT REGARDING USE OF TELEHEALTH 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.
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 physicians, nurse practitioners, physician assistants, and/or other licensed healthcare professionals (“Providers") using the online platform operated by Genesis Health Solutions, LLC ("Genesis Health Solutions," "we," or “us”). In this Consent, the terms "you" and "yours" refer to the person using the Service.
Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Some telehealth services may be delivered through real-time (synchronous) audio-video encounters, secure messaging, or asynchronous (store-and-forward) methods where your Provider reviews your information and responds without a real-time encounter. Your Provider will determine the appropriate modality based on your clinical needs and applicable state law. Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education, and may include, but is not limited to, one or more of the following:
-Electronic transmission of medical records, photo images, personal health information, or other data between a patient and a Provider;
-Interactions between a patient and Provider via audio, video, and/or data communications (such as secure messaging or email communications);
-Use of output data from medical devices, sound files, and video files.
The use of telehealth may have the following possible benefits:
Making it easier and more efficient for you to access medical care or other services and treatment for the conditions treated by your Provider(s);
Allowing you to obtain medical care or other services and treatment by Provider(s) at times that are convenient for you;
Enabling you to interact with Provider(s) without the necessity of an in-office appointment;
Reducing barriers to care, particularly for patients in geographic areas with limited access to specialty services.
While the use of telehealth in the delivery of care can provide potential benefits, there are also potential risks associated with the use of telehealth and other technology. These risks include, but may not be limited to, the following:
Quality and effectiveness limitations: The quality, accuracy, or effectiveness of the services you receive from your Provider(s) could be limited compared to in-person care;
Technology failures: Technology, including the platform, may contain bugs or other errors, including ones which may limit functionality, produce erroneous results, render part or all of the technology unavailable or inoperable, produce incorrect records, transmissions, data, or content, or cause records, transmissions, data, or content to be corrupted or lost;
Diagnostic limitations: The inability of your Provider(s) to conduct certain tests or assess vital signs in person may, in some cases, prevent the Provider(s) from providing a diagnosis or treatment, or from identifying the need for emergency medical care;
Treatment suitability: Your Provider(s) may determine that your condition is not suitable for telehealth diagnosis or treatment, and you may be required to seek alternative healthcare or emergency care services;
Condition progression: Your condition may not be cured or improved, and in some cases, may get worse;
Delays in care: Delays in medical evaluation or treatment could occur due to unavailability of your Provider(s) or deficiencies or failures of the technology or electronic equipment used;
Security breaches: The electronic systems or other security protocols or safeguards used could fail, causing a breach of privacy of your medical or other information;
Electronic communication risks: Data stored and communicated electronically, including through email or secure messaging, may be more susceptible to unintended disclosure of protected health information to third parties;
Regulatory limitations: Given regulatory requirements in certain jurisdictions, your Provider(s)' diagnosis and/or treatment options, especially pertaining to certain prescriptions, may be limited;
Incomplete medical history: A lack of access to all of your medical records may result in adverse drug interactions, allergic reactions, or other judgment errors;
Provider response time: Providers may not respond promptly to communications you submit through the platform. Telehealth communications are not monitored continuously and should not be used for urgent or emergency medical needs;
Beta-stage technology: Certain technology used to deliver care may still be in a beta testing and development phase, and before such technology is a final and finished product, it may contain errors or limitations.
If you are experiencing a life-threatening situation such as contemplating suicide, call 911 or the 988 Suicide and Crisis Lifeline at 988.
If the situation is an emergency, call 911. In some situations, telehealth is not an appropriate method of care. 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.
Providers may not respond promptly to communications you submit through the Service. If you are not experiencing an emergency or do not require immediate or urgent care, you can communicate with Providers through the secure message service in the platform. If a technical failure prevents you from communicating with your Providers through the platform, you should call 1-877-343-8004 (Monday–Friday, 9:00 AM – 6:00 PM EST).
In some cases, your treating Provider may be a nurse practitioner or physician assistant, and not a physician. By using the Service, you acknowledge and agree to be treated by non-physician providers where clinically appropriate. Your Provider for therapy or specialty services will be a licensed healthcare professional operating within their scope of practice under applicable state law. You have the right to ask your Provider about their credentials, licensure, and scope of practice at any time.
No prescription is guaranteed. Prescriptions require appropriate clinical evaluation, which may include laboratory testing, consultation, and a determination of clinical necessity. Refills require ongoing compliance with your Provider's treatment plan.
Off-Label Prescribing Generally
Some medications prescribed through our Platform may be prescribed "off-label." "Off-label" means the FDA has not approved the medication for your specific condition or indication, even though the medication itself may be FDA-approved for other uses. Off-label prescribing is legal and is a recognized medical practice. The Provider determines whether off-label prescribing is medically appropriate based on their clinical judgment, available medical evidence, and your individual health needs. Many peptide medications prescribed through our Platform are not FDA-approved for the specific indications for which they are being prescribed, and are therefore being prescribed off-label.
You should be aware of the following:
(a) FDA Approval Status: The specific peptide(s) you may be prescribed may not have been evaluated by the FDA for safety or efficacy for your particular condition or indication. Some peptides may be compounded by licensed compounding pharmacies and are not subject to the FDA's standard drug approval process.
(b) Clinical Basis: Your Provider has determined that the proposed peptide therapy is medically appropriate based on their assessment of your health history, current condition, and available clinical evidence. However, the level of clinical evidence supporting certain peptide therapies varies, and some uses may be supported by limited clinical research.
(c) Potential Risks: Peptide therapy may carry risks, including but not limited to injection site reactions, allergic reactions, hormonal fluctuations, immune system effects, interactions with other medications, and unknown long-term effects for certain compounds.
(e) Right to Decline: You are not obligated to accept off-label peptide therapy. You may decline treatment, request alternative options, or seek a second opinion at any time.
(f) Monitoring: Your Provider may recommend laboratory monitoring during peptide therapy to assess your response to treatment and monitor for potential adverse effects. Compliance with recommended monitoring is important for your safety.
Certain healthcare services provided to you by Providers via the Service may include laboratory testing. If you are signing this Consent in connection with participating in and receiving lab testing services available through the Service (the "Lab Testing Services"), you are doing so as part of a coordinated offering made available through the Service and certain affiliated and/or third-party laboratories, whereby the Service facilitates access to Providers who can order laboratory tests and provide related counseling, in each case as determined appropriate by such ordering Providers.
What you should know about laboratory testing:
Provider oversight: As part of the Lab Testing Services, you agree to receive the ordering services and oversight support services provided by such Providers, including review of test requests, receipt of test results, and related health and wellness counseling.
Blood draw methods: If determined necessary, a Provider will order laboratory blood testing, either using an at-home blood testing kit, which will be mailed to you, or you may need to go, in person, to a blood collection site to have your blood drawn.
Blood draw risks: You understand that the risks involved with blood draws include, but are not limited to, discomfort at the site of the blood draw, possible bruising, redness and swelling around the site, bleeding at the site, feeling lightheaded when blood is being drawn, and rarely, an infection at the site of the blood draw.
Accuracy limitations: These laboratory tests are provided by affiliated and/or third-party laboratories. Neither Genesis Health Solutions nor your Provider(s) can guarantee the accuracy or reliability of these tests. These laboratory tests can produce false negative, false positive, or inconclusive results. A failure or defect of these tests could also impact the understanding of your health and treatment options.
Lab responsibility: If you receive laboratory products and/or services from a lab through the Service, these are products and/or services of the lab. Genesis Health Solutions acts as a facilitator, not as a laboratory.
Specimen retention: The Service is not a laboratory and is not responsible for the retention of your specimen following the Lab Testing Services. Contact the testing laboratory if you have questions about how your sample will be retained or disposed of.
Your rights regarding test results:
You understand that laws in certain states may necessitate a delay prior to release of certain testing results to permit an opportunity for the ordering healthcare provider to review results with the patient. You hereby elect to exercise your direct right of access to test results under federal law. You knowingly waive any release requirement and affirm your desire to receive testing results as soon as the testing report is complete and available for release.
Confidentiality and follow-up:
All tests and results are confidential, but will be disclosed, as appropriate and to the extent of information needed, by and among the Service, its affiliated Providers, and the laboratory that processes your sample. Neither the Service nor its affiliated Providers will otherwise disclose your results except as authorized by you or as may be required or permitted by law. You are responsible for sharing any results with your primary care or other personal physician and for initiating follow-up with such physician for care, diagnosis, or medical treatment.
Voluntary participation: Laboratory testing is voluntary, and you may choose not to have your sample tested.
The electronic systems used in the Service 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. These safeguards include encryption in transit (TLS 1.2+) and at rest, HIPAA Security Rule compliance, and SOC 2 Type II audited controls.
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 required by law to disclose to other persons and agencies certain information obtained during the provision of healthcare services (e.g., danger to self or others; mandatory reporting of child, elder, or vulnerable adult abuse), or as otherwise set forth in the HIPAA Notice of Privacy Practices.
Electronic communication acknowledgment: Use of the Service may include email and secure messaging communications to and from you that may include your protected health information. You understand that Genesis Health Solutions does not and cannot guarantee the security or privacy of the services you use to receive communications, including, for example, your personal email service provider or mobile device. The internet is not 100% secure, and you acknowledge this inherent risk in using telehealth services.
By clicking "I Agree," checking a related box, using any other acceptance protocol presented through the Service, or otherwise affirmatively accepting this Consent, you acknowledge and agree to the following:
Healthcare services provided to you by Providers via the Service will be provided by telehealth;
In some cases, your treating Provider may be a nurse practitioner or physician assistant, and you agree to be treated by non-physician providers where clinically appropriate;
Certain technology, including the Service, may be used while still in a beta testing and development phase, and may contain bugs or other errors that could limit or impact the quality, accuracy, and/or effectiveness of the medical care or other services you receive;
Certain diagnostic testing services, including laboratory products and services offered through the Service, may contain defects that could limit or impact the quality, accuracy, and/or effectiveness of the medical care or other services you receive;
The delivery of healthcare services via telehealth is an evolving field, and the use of telehealth or other technology in your medical care and treatment may include uses not specifically described in this Consent;
No potential benefits from the use of telehealth or other technology, and no specific results, can be guaranteed, including any laboratory testing results or related diagnosis or treatment by your Provider(s);
Your condition may not be cured or improved, and in some cases, may get worse;
There are limitations in the provision of medical care or other services and treatment via telehealth and technology, including the Service, and you may not be able to receive diagnosis and/or treatment through telehealth for every condition for which you seek care;
You have had the opportunity to discuss the use of telehealth, including the Service, with your Provider(s), including the benefits and risks of such use and the alternatives to the use of telehealth;
Your Provider(s) will assess your medical condition and, in their sole discretion, may determine whether it is medically appropriate to diagnose and/or treat your condition via telehealth;
Your Provider(s) may determine in their sole discretion that your condition is not suitable for telehealth diagnosis or treatment, and that you may need to seek care from a specialist or other healthcare provider outside of the telehealth platform;
You understand that the use of the Service involves electronic communication to and from you of your personal medical information, including through email and secure messaging;
It is your duty to provide Genesis Health Solutions and your Provider(s) truthful, accurate, and complete information, including all relevant information regarding care that you may have received or may be receiving from other healthcare providers, and your emergency contact information;
We do not bill insurance companies, Medicare, or other third-party payers. You are responsible for the full cost of services.
You have the right to withdraw your consent to the use of telehealth in the course of your care, without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which you are entitled. You understand, however, that the Providers who utilize the Service do not offer in-person treatment.
Any withdrawal of your consent will be effective upon receipt of written notice to your Provider(s) at support@gen3health.com or by calling 1-877-343-8004, except that such withdrawal will not have any effect on any action taken by Genesis Health Solutions or your Provider(s) in reliance on this Consent before it received your written notice of withdrawal. Any withdrawal of your consent will not affect any other provision of this Consent, and you will continue to be bound by the remaining terms of this Consent.
You are free to obtain your medical examination, consultation, and treatment from another healthcare provider that is not associated with Genesis Health Solutions or the Medical Group. Choosing to use or not use the Service will not affect your eligibility for any future care from any provider. If you wish to transfer your care, you may request a copy of your medical records in accordance with the HIPAA Notice of Privacy Practices.
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, you may consult the Federation of State Medical Boards at https://www.fsmb.org. State-specific resources include:
California:
Medical Board of California: https://www.mbc.ca.gov or (800) 633-2322
Board of Behavioral Sciences: http://www.bbs.ca.gov or (916) 574-7830
Florida:
Florida Board of Medicine: https://flboardofmedicine.gov or (850) 245-4131
Kansas:
Kansas State Board of Healing Arts: https://ksbha.org or (785) 236-1560
New Jersey:
New Jersey State Board of Medical Examiners: https://www.njconsumeraffairs.gov/bme or (973) 504-6430
New York:
New York State Department of Health Office of Professional Medical Conduct: https://health.ny.gov/professionals/doctor/conduct or (518) 402-0836
Washington:
Washington Medical Commission: https://wmc.wa.gov or (360) 236-2700
This Consent is intended to comply with telehealth informed consent requirements in all states where the Medical Group operates and its Providers are licensed. If your state of residence imposes additional telehealth consent requirements, those requirements are incorporated by reference. You represent that you reside in a state where the Services are available and that all information you provide is accurate and truthful.
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services Open Payments web page is provided here: https://openpaymentsdata.cms.gov. The federal Physician Payments Sunshine Act requires that detailed information about payments and other transfers of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. No providers have reportable manufacturer payments.
CONTACT INFORMATION
Genesis Health Solutions, LLC
30 N Gould St, #51485
Sheridan, WY 82801
Email: support@gen3health.com
Phone: 877-343-8004