Telehealth Consent

Beyond Esthetics ("Beyond Esthetics," "we," "us") facilitates access to licensed healthcare providers affiliated with Elite Care Health ("Providers") who deliver telehealth consultations, including weight management, peptide, and sexual health programs. Beyond Esthetics is not a primary care provider, hospital, or emergency service.

By proceeding, you ("Patient") acknowledge that you have read, understood, and agree to 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, another 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 Beyond Esthetics and proceeding with a consultation, you:

• Voluntarily consent to participate in telehealth consultations with licensed Providers.
• Acknowledge that you have truthfully and completely disclosed your health history, current medications, allergies, and any other relevant medical information.
• Understand that withholding or misrepresenting health information may result in inappropriate treatment recommendations, and accept full responsibility for inaccurate disclosures.
• 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 refer you to in-person care.
• Agree that no prescription is guaranteed and that a consultation does not guarantee any particular outcome or treatment plan.

You acknowledge the following limitations and risks of telehealth:

• Inability to perform a physical examination 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, the information transmitted may be insufficient for appropriate medical decision-making, and the Provider may refer you to in-person care.
• Treatments may cause side effects. Your Provider will review the risks with you before prescribing.

Telehealth services may be available in all 50 states where clinically appropriate and permitted by applicable law. You represent that you are located in a state where services are offered at the time of your consultation.

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

Beyond Esthetics is not for emergencies. Telehealth is not appropriate for medical emergencies.

If you are experiencing a medical emergency, including 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 our website or messaging to request emergency care.

A telehealth consultation creates a limited Provider-patient relationship for the specific purpose of the program you requested. This relationship:

• Does not constitute an ongoing primary care relationship.
• Does not create a duty for the Provider to provide future care beyond the scope of the consultation or active program.
• May be ended 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. We use HIPAA-compliant 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 beyondestheticsspa@gmail.com or by canceling your program. Withdrawal of consent does not affect services already provided.

To the fullest extent permitted by applicable law, Beyond Esthetics, its officers, 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 before prescribing.
• No in-person physical examination will be performed as part of this consultation.
• My medical information may be stored electronically for record-keeping.

I acknowledge the following potential risks:

• Incomplete evaluation due to the lack of a physical exam. Certain conditions may require in-person assessment.
• Technical difficulties could disrupt the consultation.
• Medical decisions may be delayed if additional information or testing is required.
• Potential loss of privacy due to electronic communication vulnerabilities.

I understand that:

• My telehealth consultation is confidential and protected under HIPAA.
• The Provider will not share my information without my consent unless legally required.
• I must take reasonable precautions to protect my privacy on my end (for example, using a secure connection).
• I am not obligated to proceed with a telehealth evaluation if I prefer in-person care.
• Prescriptions are not guaranteed and are issued only if approved by a licensed Provider based on their medical judgment.
• If approved, treatment will be fulfilled by Rx Ave Health, a licensed U.S. pharmacy, and shipped directly to me.
• Follow-up check-ins are required before additional treatment may be approved.
• Any 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, have had the opportunity to ask questions, understand the risks, benefits, and limitations of telehealth, and voluntarily consent to remote medical evaluation.

Beyond Esthetics, 2021 Park Ave West, Ontario, OH 44906. Email: beyondestheticsspa@gmail.com. Phone: (567) 560-5558.