NEXVITALITY

Informed Consent

Informed Consent for telehealth Services

Before you give your informed consent to request and receive telehealth services, please be aware of how obtaining health services remotely from our physicians and other licensed health care professionals (together, the “Providers”) through an online telehealth platform developed and maintained by TeleHealthDoc365, (the “Platform”) differs from in-person care. Some of the risks associated with receiving telehealth services are described in this Informed Consent. There may be other risks to telehealth services that are not currently known.

Our Providers are affiliated with one or more of the following TeleHealthDoc365 professional entities: TeleHealthDoc365 Medical Services, P.C. (NY), TeleHealthDoc365 Medical Services, P.C. (NJ), and Preventive Medicine Associates, P.C. (CA) (collectively, “TeleHealthDoc365 Professional Entities”). If you are connecting with a Provider in NJ or CA, you will be served by our NJ or CA professional entity, respectively. All other locations will be served by TeleHealthDoc365 Medical Services, P.C. (NY). In this Informed Consent, the terms “TeleHealthDoc365,” “we”, “us”, or “our” refers to the TeleHealthDoc365 Professional Entities and TeleHealthDoc365, Inc. The terms “you” and “yours” refer to the patient using the Platform to request telehealth services from Providers affiliated with the TeleHealthDoc365 Professional Entities. Please read each item carefully.