Telehealth Consent

Your Brand LLC ("Your Brand," "we," "us") facilitates access to licensed healthcare providers ("Providers") who deliver telehealth consultations through Your Brand's platform. These services are limited to health optimization, including but not limited to hormone therapy, peptide therapy, weight management, and metabolic wellness. Your Brand is not a primary care provider, hospital, or emergency service.

By proceeding, you ("Patient," "Member") acknowledge you have read, understood, and agree to the terms of this Telehealth Consent.

Telehealth involves the delivery of healthcare services using electronic communications, including video, audio, text, and secure messaging. You understand that:

• Telehealth consultations may differ from in-person visits. The Provider may not be able to perform a physical examination.
• Technical difficulties may interrupt or prevent a consultation. In such cases, an alternative method of communication may be used.
• Not all health conditions are appropriate for telehealth. Your Provider will determine whether your condition can be adequately assessed and treated via telehealth.
• A telehealth Provider-patient relationship is not a substitute for an ongoing relationship with a primary care provider.

By submitting your information to Your Brand and proceeding with a consultation, you:

1. Voluntarily consent to participate in telehealth consultations with Providers affiliated with or accessible through Your Brand's platform.
2. Acknowledge that you have truthfully and completely disclosed your health history, current medications, allergies, and any other relevant medical information.
3. Understand that withholding or misrepresenting health information may result in inappropriate treatment recommendations and that you accept full responsibility for inaccurate disclosures.
4. Accept that Providers may determine, at their sole clinical discretion, that telehealth services are not appropriate for your condition, and may decline to prescribe or may refer you to in-person care.
5. Agree that no prescriptions are guaranteed and that a medical consultation does not guarantee any particular outcome or treatment plan.

You acknowledge the following limitations and risks inherent to telehealth:

• Inability to perform physical examinations may limit the Provider's ability to diagnose certain conditions.
• Delays in information transmission due to technology failures could affect care.
• Security protocols are in place, but no electronic transmission is completely without risk.
• In rare cases, information transmitted may be insufficient to allow appropriate medical decision-making, and the Provider may need to refer you to in-person care.

Your Brand's telehealth services are only available in states where our affiliated Providers hold active, valid medical licenses. Services are currently available in select U.S. states; availability may expand as our provider network grows. Availability may change as provider licensing status changes. You represent that you are located in a state where services are currently offered at the time of your consultation.

If you are unsure whether services are available in your state, contact us at support@yourbrand.com before enrolling.

Your Brand is not an emergency service. Telehealth is not appropriate for medical emergencies.

If you are experiencing a medical emergency, including but not limited to chest pain, difficulty breathing, stroke symptoms, severe bleeding, or thoughts of harming yourself or others, call 911 immediately or go to the nearest emergency room.

Do not use Your Brand's platform or messaging system to request emergency care.

A telehealth consultation through Your Brand's platform creates a limited provider-patient relationship for the specific purpose of health optimization services. This relationship:

• Does not constitute an ongoing primary care relationship.
• Does not create a duty by the Provider to provide future care beyond the scope of the initial consultation or active membership.
• May be terminated by the Provider at any time if clinically appropriate or if you violate the Terms of Service.

All health information you provide is handled in accordance with our Privacy Policy and applicable HIPAA regulations. Your Brand uses HIPAA-compliant technology platforms to store and transmit your protected health information (PHI). Consultations are not recorded without your explicit consent. Third-party service providers with access to PHI are bound by Business Associate Agreements (BAAs).

You may withdraw this consent at any time by contacting us at support@yourbrand.com or by canceling your membership. Withdrawal of consent will not affect the lawfulness of any services already rendered.

To the fullest extent permitted by applicable law, Your Brand LLC, its officers, directors, employees, affiliated Providers, and technology partners shall not be liable for any indirect, incidental, special, or consequential damages arising out of telehealth services, including outcomes related to delayed diagnosis, technical failure, or treatment decisions made in reliance on incomplete information provided by the Patient.

I acknowledge that:

• The evaluation will be conducted remotely via video, phone, or digital communication.
• The provider will rely on my self-reported medical history to make an informed decision.
• The telehealth consultation does not guarantee clearance for medication.
• The provider may request additional information or lab tests if needed before prescribing.

I understand that:

• Telehealth involves electronic communication to evaluate, diagnose, and manage my healthcare.
• No in-person physical examination will be performed as part of this consultation.
• The provider may use third-party telemedicine software for video or phone calls.
• My medical information may be stored electronically for record-keeping.

I acknowledge the following potential risks:

• Incomplete evaluation due to lack of physical exam. Certain conditions may require in-person assessment.
• Technology limitations. Technical difficulties could disrupt the consultation.
• Delays in medical decision-making if additional information or testing is required.
• Potential loss of privacy due to electronic communication vulnerabilities.

I acknowledge that:

• My telehealth consultation is confidential and protected under HIPAA (Health Insurance Portability and Accountability Act).
• The provider will not share my information without my consent unless legally required.
• I must take precautions to ensure privacy on my end (e.g., using a secure connection).
• I am not obligated to proceed with telehealth-based evaluation if I prefer in-person care.
• I consent to receiving telehealth medical services as part of my Your Brand membership.
• I understand that my membership includes medical review, Provider support, messaging, and treatment fulfillment if approved by a licensed Provider.
• I understand that prescriptions are not guaranteed and are only issued if approved by a licensed Provider based on their medical judgment.
• I understand that if approved, treatment will be fulfilled through a licensed U.S. compounding pharmacy and shipped directly to me as part of my membership.
• I understand that follow-up check-ins are required every 3 months before additional treatment may be approved.
• I understand that any required lab tests or additional evaluations requested by my Provider are my responsibility.

By agreeing to this form, I confirm that:

• I have read and understand this Telehealth Consent Form.
• I have had the opportunity to ask questions about my telehealth consultation.
• I understand the risks, benefits, and limitations of telehealth-based evaluation and treatment.
• I voluntarily consent to receiving remote medical evaluation through Your Brand.

If you have questions about this Telehealth Consent, contact us at support@yourbrand.com.