Telehealth Consent

Telehealth Consent PLEASE READ CAREFULLY

By accepting this Consent, you confirm that you understand and voluntarily agree to receive healthcare services via telehealth under the terms described above.

PLEASE READ CAREFULLY.

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, UNDERSTOOD, AND AGREE TO BE BOUND BY THIS TELEHEALTH INFORMED CONSENT (“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 PERSON WHO CLICKS “I AGREE” OR OTHERWISE INDICATES ACCEPTANCE OF THIS CONSENT ON YOUR BEHALF.

IF YOU ARE EXPERIENCING A LIFE-THREATENING EMERGENCY, INCLUDING THOUGHTS OF SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988 IMMEDIATELY.

 

 

Purpose

The purpose of this Telehealth Informed Consent (“Consent”) is to provide information regarding the use of telehealth services and to obtain your informed consent to receive healthcare services via telehealth technologies. Healthcare services are provided by licensed physicians, physician assistants, and nurse practitioners (“Providers”) through the online platforms owned and operated by Kyntra Medical (the “Service”).

As used in this Consent, “you” and “your” refer to the individual using the Service.

 

 

Use of Telehealth

Telehealth involves the delivery of healthcare services through electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth services may be used for diagnosis, treatment, follow-up care, and/or patient education.

Telehealth services may include, but are not limited to:

  • Electronic transmission of medical records, images, personal health information, or other data

  • Audio, video, and/or secure messaging communications between you and your Provider

  • Review of information from connected or patient-reported medical devices

Alternative methods of care, including in-person care, may be available to you. You are encouraged to discuss all available options with your Provider.

 

 

Anticipated Benefits

Potential benefits of telehealth may include:

  • Improved access to healthcare services

  • Greater convenience and flexibility in receiving care

  • Reduced need for in-person office visits

  • Timely communication with Providers

 

 

Potential Risks

While telehealth offers many benefits, there are potential risks, including but not limited to:

  • Limitations in the quality, accuracy, or effectiveness of care due to the absence of in-person evaluation

  • Technology failures, interruptions, errors, or data loss

  • Inability to perform certain physical examinations, tests, or assessments

  • Delays in diagnosis or treatment due to technical or Provider availability issues

  • Security breaches or unintended disclosure of protected health information

  • Regulatory or jurisdictional limitations on diagnosis, treatment, or prescribing

  • Incomplete access to your medical history, which may increase the risk of medication interactions or allergic reactions

  • For mental health services, temporary emotional discomfort or symptom worsening as treatment progresses

You acknowledge that these risks may result in outcomes that differ from in-person care.

 

 

Emergency Situations and Follow-Up Care

Telehealth is not appropriate for medical emergencies.

  • If you believe you are experiencing a medical emergency, call 911 immediately.

  • If you are experiencing thoughts of self-harm or suicide, call 911 or the 988 Suicide & Crisis Lifeline.

Providers may not be able to respond immediately to messages submitted through the Service. If urgent or emergent care is required, you must seek care from an emergency room or other appropriate healthcare facility.

 

 

Data Privacy and Protection

The Service uses electronic systems with security measures designed to protect the confidentiality and integrity of your information. However, no system can guarantee absolute security.

Your protected health information will not be disclosed without your authorization except as permitted or required by law, including for purposes of treatment, payment, healthcare operations, mandatory reporting obligations, or as otherwise described in your Provider’s Notice of Privacy Practices.

You understand that electronic communications, including email, may involve increased risk of unintended disclosure and that Kyntra Medical cannot guarantee the security of external communication services you use.

 

 

Your Acknowledgments and Consent

By accepting this Consent, you acknowledge and agree that:

  • Healthcare services provided through the Service are delivered via telehealth.

  • Your Provider may be a physician, nurse practitioner, or physician assistant, and you consent to treatment by non-physician providers when applicable.

  • Certain technologies used in the Service may still be under development and may contain errors or limitations.

  • Diagnostic testing and laboratory services may have inherent limitations or defects that could affect accuracy.

  • Telehealth is an evolving field, and technologies or methods not specifically described here may be used.

  • No specific outcomes or results are guaranteed, and your condition may remain the same or worsen.

  • Not all medical conditions can be appropriately diagnosed or treated via telehealth.

  • You have had the opportunity to ask questions and discuss telehealth risks, benefits, and alternatives with your Provider.

  • Sessions will not be recorded by you or your Provider.

  • Your Provider will determine, in their professional judgment, whether telehealth is appropriate for your care.

  • You may withdraw consent to telehealth at any time by providing written notice, understanding that Providers using the Service do not offer in-person care.

  • Withdrawal of consent does not affect actions already taken in reliance on this Consent.

  • You agree to provide accurate, complete, and truthful medical and personal information.

  • Your Provider may determine that your condition is not appropriate for telehealth and may refer you to another provider or setting.

 

 

Pharmacy Services and Payment Responsibilities

Kyntra Medical may use pharmacy partners to fulfill prescriptions and deliver medications to you. You may choose any pharmacy of your choice by notifying support and your prescribing Provider through the Service.

You acknowledge that:

  • Prescriptions may be filled or transferred among pharmacy partners on your behalf

  • You are responsible for all costs associated with use of the Service and prescriptions

  • You will not submit claims for services or prescriptions to Medicare, Medicaid, or other federal, state, or private insurance programs

 

 

Provider Concerns

If you have concerns regarding a medical professional, you may contact the appropriate medical licensing board in your state.

 

 

By accepting this Consent, you confirm that you understand and voluntarily agree to receive healthcare services via telehealth under the terms described above.