Telehealth Informed Consent

This document explains telehealth and asks for your consent to receive care this way from the licensed physicians of HerTide Health PLLC, the professional medical practice affiliated with HerTide Health. You accept this consent during onboarding, before any physician evaluates you or writes a prescription. Please read it carefully and keep a copy for your records.

What Telehealth Is

Telehealth is the delivery of health care using secure electronic communication, such as video, voice, secure messaging, and the exchange of intake information, laboratory results, and photographs, when the patient and physician are in different locations. Your care through HerTide Health is delivered remotely. For the treatments offered on this platform, no in-person visit is required, though a physician may determine that an in-person visit or in-person testing is necessary for your care.

Potential Benefits

• Improved access to care without the need to travel to a clinic.
• More convenient scheduling and follow-up.
• The ability to share labs, history, and questions with your physician through a secure platform.

Potential Risks and Limitations

• A remote evaluation relies on the information you provide. Because the physician cannot physically examine you in the same room, some conditions may be harder to assess and, in rare cases, could be missed or misjudged.
• Technology may fail or be interrupted, which can delay or affect your care.
• Despite strong security measures, no electronic transmission of information can be guaranteed to be fully secure.
• Your physician may decide that telehealth is not appropriate for your situation and may recommend in-person care instead.

Compounded Medications

Some therapies offered through HerTide Health, including certain hormone and peptide treatments, are compounded by BoomRx, a licensed pharmacy, specifically for you. Compounded medications are not reviewed or approved by the U.S. Food and Drug Administration for safety, effectiveness, or manufacturing quality in the way that FDA-approved commercial products are. Your physician will discuss the expected benefits, known risks, side effects, and alternatives before you begin any therapy.

No Guarantee of Treatment or Outcome

Completing an assessment and consenting to telehealth does not guarantee that you will be prescribed any medication. The treating physician decides, using independent medical judgment, whether treatment is appropriate for you. No specific result or outcome is promised.

Not for Emergencies

Telehealth through HerTide Health is not for medical emergencies. If you are having an emergency, call 911 or go to the nearest emergency room.

Privacy of Your Information

Information shared during your telehealth care is protected health information and is handled in accordance with our HIPAA Notice of Privacy Practices.

Your Rights and Consent

By consenting to telehealth care, you acknowledge and agree that:

• You have read and understood this consent and have had the opportunity to ask questions.
• You understand the benefits, risks, and limitations of telehealth described above.
• The information you provide is true and complete to the best of your knowledge, and you will keep it current.
• You may withhold or withdraw your consent to telehealth at any time without affecting your right to future care, and you may request in-person care where available.
• You are physically located in a U.S. state where the treating physician is licensed.

Questions