Telehealth Informed Consent

MD Integrations via the PHASES platform  ·  v1.4

Telehealth Informed Consent

This Telehealth Informed Consent (“Consent”) describes the telehealth services provided by MD Integrations, an independent medical group, and the independent, board-certified physicians licensed in your state who contract with it (the “Providers”), through the PHASES platform operated by KIT Products, Co. (“PHASES”). Please read it carefully. By checking the acceptance box, you consent to receive care by telehealth on the terms below.

Your medical intake

Before your evaluation, you will complete a medical intake form. The information you provide in your medical intake will be reviewed by a board-certified physician licensed in the state where you are located, who will use it to evaluate you and, if appropriate, create a medical treatment plan for you. By accepting this Consent, you consent to be evaluated by a physician for treatment.

What telehealth is

Telehealth is the delivery of health care services using electronic communications where the patient and provider are not in the same physical location. Your care may include asynchronous review of your medical intake form, photographs, and records (“store and forward”), live video or audio consultations, and secure messaging. Your Provider will determine which modality is clinically appropriate and permitted in your state, and may require a live visit or decline to treat you by telehealth.

How your Provider may communicate with you

By accepting this Consent, you consent to your Provider and MD Integrations communicating with you, and delivering care, through any of the following methods: video files, audio files, telephone calls, direct text messaging, email, secure messaging through the PHASES platform, and invitations to use audio or video chat services that comply with the Health Insurance Portability and Accountability Act (HIPAA). Your Provider will choose the method that is clinically appropriate and permitted in your state. Some of these methods, such as standard text messaging and email, may not be encrypted, and information sent through them could be intercepted or seen by others with access to your device or account. You may ask your Provider to limit communications to secure methods, such as platform messaging, at any time.

No guarantee of treatment

There is no guarantee that you will be treated by an MD Integrations Provider. As determined by the Provider, care or specific treatments may not be appropriate for every patient. Each Provider reserves the right to deny care for potential misuse of services, or for any other reason, if in the Provider’s professional judgment the provision of services is not medically or ethically appropriate. There is no guarantee that you will be issued a prescription, and the decision whether a prescription is appropriate will be made in the professional judgment of the Provider.

Expected benefits

Telehealth can improve access to care, reduce travel and wait times, and allow ongoing management of your treatment from home.

Possible risks

• Your Provider does not perform a physical, in-person examination, and must rely on the information you provide. Missing or inaccurate information can affect clinical judgment and result in adverse drug reactions or other harm.
• Delays in evaluation or treatment can occur due to technology failures, transmission problems, or scheduling.
• In rare circumstances, security protocols could fail and cause a breach of privacy of your health information.
• Telehealth may not be as complete as in-person care, and some conditions cannot be appropriately treated by telehealth. Your Provider may determine you need in-person care and refer you accordingly.
• Medications carry risks and side effects, which your Provider and the dispensing pharmacy will explain. Compounded medications prepared for you by a licensed compounding pharmacy are not FDA-approved products.

Alternatives to treatment

You always have alternatives to the treatment offered through the PHASES platform. Depending on your condition and goals, alternatives may include FDA-approved medications, other medications or therapies, lifestyle changes such as diet and exercise, or no treatment. You may also seek in-person evaluation and care at any time from your primary care provider or, where applicable, a specialist, and you are encouraged to discuss these options with them. Telehealth is your choice, not a requirement.

Emergencies and urgent care

The PHASES platform and the Providers do not provide emergency or urgent care. If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency department. If you have an urgent medical condition that is not an emergency, seek in-person care at an urgent care center or with your own doctor. Although you may message your Provider through the platform, messages may not be reviewed immediately, so do not use platform messaging for urgent or emergency symptoms.

Your rights

• You may withhold or withdraw this Consent at any time, without affecting your right to future care or treatment. Withdrawal will end telehealth services going forward.
• You have the right to ask questions about your treatment, the qualifications and licensure of your Provider, and any medication prescribed, and to receive answers before treatment proceeds.
• You have the right to have your prescription sent to any licensed pharmacy of your choosing, as described under “Choice of pharmacy” below.
• The laws that protect the confidentiality of medical information apply to telehealth. Your information will be handled as described in the Notice of Privacy Practices and the PHASES Privacy Policy.
• You have the right to access your medical records as described in the Notice of Privacy Practices.
• No results are guaranteed. Your condition may not improve, and in some cases may worsen, despite appropriate care.

Your responsibilities

You confirm that you are the patient who will be evaluated and that you will complete the medical intake form yourself, for yourself, and not on behalf of anyone else. You agree to identify in your medical intake the health concern or goal for which you are seeking treatment, and to provide complete and accurate health information, including all medications, allergies, and conditions, understanding that your Provider will rely on it. You also agree to update your Provider if your health changes, to use medications only as prescribed and only for yourself, and to participate in any follow-up your Provider requires, including lab work where ordered. Failure to complete required follow-up may result in discontinuation of treatment.

Choice of pharmacy

PHASES works with preferred partner pharmacies, but you are not required to use them. You may direct that your prescription be sent to any licensed pharmacy of your choosing. To do so, before your prescription is sent to a pharmacy, message your Provider through your patient account or email support@wearephases.com with the subject line “Pharmacy Request,” and include the name, address, and telephone number of the pharmacy you choose. If you choose another pharmacy, you will not be charged PHASES medication fees for that prescription, you will pay that pharmacy directly at its own prices, and the consultation fee still applies. Another pharmacy may not be able to prepare a compounded medication, ship to your state, or fill your prescription on the same timeline.

Financial disclosure and agreement not to submit claims

Services are self-pay only. Fees are disclosed before you are charged. PHASES collects consultation fees on behalf of MD Integrations as an administrative service. Neither PHASES, MD Integrations, nor the Providers bill insurance or any government health care program. You may cancel at any time before a Provider begins reviewing your medical intake and receive a full refund of all amounts paid. Once a Provider begins reviewing your medical intake, the consultation fee is non-refundable, whether or not a prescription is issued. If the Provider determines that treatment is not clinically appropriate for you, you will not be charged for medication, and any authorization hold placed on your payment method for the medication cost will be released, typically within 3 to 5 business days depending on your card issuer, as described in the Refund and Cancellation Policy. I agree that I will not submit, and will not ask or permit anyone else to submit, a claim for payment or reimbursement for these telehealth services to Medicare, Medicaid, or any other federal or state health care program, or to any private insurer, health plan, or other third-party payor.

Indemnification

I agree to indemnify, defend, and hold harmless PHASES; MD Integrations and its affiliated entities; each of their respective officers, directors, employees, and contractors; and the Providers and other physicians and clinicians who contract with MD Integrations, from and against claims, damages, losses, and expenses (including reasonable attorneys’ fees) arising from my breach of this Consent or the PHASES Terms of Service (including my agreement not to submit claims to insurance or government payors), my misuse of the services or of any medication, or my provision of false, inaccurate, or materially incomplete information, as further described in Section 12 of the PHASES Terms of Service. This does not require me to indemnify anyone for losses caused by their own negligence, willful misconduct, or violation of law, and it does not waive any claim I may have against a Provider for professional negligence. MD Integrations, its affiliated entities, and the Providers may enforce this section directly.

Acknowledgment

By checking the box at checkout, I confirm that I have read and understand this Consent, including my responsibilities described above, that I have had the opportunity to ask questions, that I am at least 18 years old, and that I will be located in the state I identify in my medical intake. I voluntarily consent to receive telehealth services from the Providers.

 

Effective date September 21, 2026. Version 1.4.