Informed Consent to Telehealth

By proceeding with a medical intake on Basis, you consent to receive health care services via telehealth. Please read this consent carefully before you continue.

What telehealth means here

Telehealth is the delivery of health care services using electronic communications rather than an in-person visit.

Your consultation will normally be conducted asynchronously. You complete a detailed medical intake, and a licensed provider reviews your information and communicates with you electronically. Depending on your state and your clinical circumstances, a live video or telephone consultation may be required before treatment can be prescribed.

Who provides your care

Your care is provided by an independent, licensed healthcare provider contracted through Locumtele, who is licensed in the state in which you are physically located at the time of your consultation.

Basis Wellness Developments LLC does not employ these providers, does not direct or influence their clinical judgement, and does not practise medicine.

Benefits of telehealth

• access to care without travelling to a clinic
• convenience, flexibility and privacy
• access to providers who may not be available locally
• ongoing communication with your provider through a secure platform

Risks and limitations of telehealth

You should understand that:

• Your provider will not physically examine you. Diagnosis and treatment recommendations are based entirely on the information you provide. Incomplete or inaccurate information may result in inappropriate treatment, delayed treatment, or harm to your health.
• Telehealth is not appropriate for every condition or every patient. Your provider may determine that in-person care is required and may decline to treat you.
• Technology failures, delays or outages may interrupt or delay your care.
• Electronic communication carries a risk of interception or unauthorised access despite the security measures we and our partners use.
• Telehealth is not a substitute for a relationship with a primary care provider. We strongly encourage you to maintain one and to inform them of any treatment you receive through Basis.
• In rare cases, information transmitted may be insufficient or of poor quality, requiring rescheduling or an in-person visit.

Medications

Medication prescribed to you may be FDA-approved or compounded.

Compounded medications are not reviewed or approved by the FDA for safety or effectiveness. They are prepared by Rush Pharmacy, a licensed compounding pharmacy, in accordance with applicable state and federal law.

GLP-1 medications commonly cause side effects, most often gastrointestinal, particularly during the period when your dose is being increased. Your provider will discuss the risks, benefits, alternatives and expected side effects of any treatment. You should raise any concerns with your provider before beginning treatment and at any point during it.

You should contact your provider promptly if you experience side effects that concern you, and seek emergency care immediately if you experience severe symptoms.

Emergencies

Telehealth is not for emergencies. If you are experiencing a medical emergency, call 911 or go to your nearest emergency department. Do not wait for a response through this platform.

Records and privacy

A record of your telehealth consultation will be kept by your treating provider. Your information is protected under applicable federal and state privacy law. You have the right to request access to the medical records held by your provider.

Details of how Basis handles your information are set out in our Privacy Policy and our Consumer Health Data Privacy Policy.

Your rights

• You may withhold or withdraw this consent at any time, without affecting your right to future care or treatment.
• You may request a referral for in-person care at any time.
• You may request that a specific person is not present during a consultation.
• You have the right to ask questions about your treatment at any time.

Your consent

By checking the consent box and proceeding, you confirm that:

• you have read and understood this consent
• you have had the opportunity to ask questions and have those questions answered
• you are at least 18 years of age
• you are physically located in the United States
• the medical and personal information you have provided is accurate and complete to the best of your knowledge
• you understand that a provider may decline to prescribe treatment
• you consent to receive health care services via telehealth

Questions about this consent: support@basiswellness.com or +1 (877) 239-5077