Read this consent before using telehealth services. By accepting it electronically, you confirm that you understand telehealth, its benefits, risks, and alternatives, and you consent to receive care from the independent Provider Group and clinician identified on the secure patient-care platform.
1 Purpose and Parties
Klarvia Health provides nonclinical technology and administrative coordination that helps connect patients with independent healthcare provider groups. Klarvia Health is not a medical practice, healthcare provider, pharmacy, or emergency service, and does not diagnose, treat, or prescribe.
Your medical care is provided by the independent professional practice identified on the secure patient-care platform (the Provider Group) and by your licensed physician or other qualified healthcare professional (the clinician). The platform will identify the Provider Group and the clinician before or during the consultation. The Provider Group and the clinician are responsible for all clinical decisions and services.
2 What Telehealth Means
Telehealth is healthcare delivered when you and the clinician are in different locations using electronic communications. Depending on your needs and the clinician’s judgment, telehealth may include:
- Online medical questionnaires and intake forms.
- Secure messages, phone calls, or live audio or video consultations.
- Photographs, laboratory results, medical records, and other health information you submit or authorize.
- Electronic care instructions, follow-up, and prescription or pharmacy coordination when clinically appropriate.
The clinician may determine that telehealth is not appropriate for you or that an in-person examination, diagnostic testing, specialty care, urgent care, or emergency care is needed.
3 Expected Benefits
Potential benefits of telehealth include more convenient access to care, less travel, faster exchange of information, and the ability to receive care from a licensed clinician when an in-person visit is not necessary. Benefits are not guaranteed.
4 Material Risks and Limitations
Telehealth has risks and limitations that may affect the quality, timing, privacy, or outcome of care. These include:
- A remote consultation may not provide the information available through a physical examination, direct observation, or immediate diagnostic testing.
- Incomplete, inaccurate, outdated, or misunderstood information can contribute to a delayed, incomplete, or incorrect evaluation or treatment.
- Technology, internet, device, power, audio, video, or platform failures can interrupt, delay, or prevent care.
- Electronic communications can be accessed, lost, corrupted, or disclosed despite reasonable safeguards.
- Records, images, messages, laboratory information, or prescriptions may be delayed or unavailable.
- A clinician may need to end the telehealth consultation and direct you to in-person or emergency care.
No technology can eliminate all privacy or security risks, and no clinician can guarantee a diagnosis, prescription, treatment, or health outcome.
5 Your Responsibilities
To support safe and lawful care, you agree to:
- Provide your accurate physical location at the time of each consultation. Your location determines whether the clinician can legally treat you and which state requirements apply.
- Provide complete, current, and truthful information about your identity, symptoms, health history, allergies, medications, pregnancy status, and other information relevant to your care.
- Use a private location and a secure device and connection when reasonably possible, and tell the clinician if another person is present or participating.
- Follow care instructions and promptly seek in-person or emergency care when directed or when your condition worsens.
- Ask questions and tell the clinician when you do not understand the information, instructions, risks, or alternatives.
- Not impersonate another person, allow another person to use your account, or submit information on another person’s behalf without legal authority.
6 Emergencies
Telehealth through Klarvia Health is not an emergency service and is not appropriate for urgent or life-threatening conditions. If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency room. Examples include chest pain, severe difficulty breathing, signs of stroke, uncontrolled bleeding, loss of consciousness, a severe allergic reaction, or thoughts of harming yourself or another person.
7 Clinical Independence and Prescriptions
The clinician independently determines whether a diagnosis, treatment, test, referral, or prescription is appropriate. Completing an intake or paying for a service does not guarantee treatment or a prescription. A clinician may decline, modify, or discontinue treatment and may require an in-person examination or additional testing.
You may select a pharmacy when required by law and subject to availability. Dispensing, shipping, substitutions, delays, and product availability by the pharmacy are outside Klarvia Health’s clinical control.
Some prescribed medications may be compounded. Compounded medications are prepared for an individual patient by a pharmacy and are not approved by the U.S. Food and Drug Administration in the same manner as commercially manufactured medications. The prescribing clinician will decide whether a compounded medication is appropriate and must explain the medication-specific risks and alternatives. This consent does not replace any separate medication consent, pharmacy notice, or patient instructions.
8 Privacy, Medical Records, and Electronic Communications
Telehealth information will be handled in accordance with applicable privacy and health-records laws and the Provider Group’s Notice of Privacy Practices. The secure patient-care platform and authorized providers may process information to support identity verification, intake, communication, clinical care, recordkeeping, payment, security, and operations as permitted by law.
Your telehealth communications and records may become part of the Provider Group’s medical record and may be shared with other healthcare professionals, laboratories, pharmacies, service providers, or payers when authorized or permitted by law. Ordinary email and text messages may not offer the same protections as the secure patient-care platform. Do not use general support channels for emergencies or detailed clinical communications.
9 Recordings, Transcription, and Automated Tools
Telehealth sessions will not be recorded in audio or video, unless you receive a separate notice and provide the consent required by law. Clinical records may include written notes, secure messages, images, forms, and other information customarily maintained for care.
Technology may support administrative, security, or information-preparation functions for the clinician’s review. Automated tools do not independently diagnose you, determine clinical eligibility, or prescribe medications. The clinician remains responsible for medical judgment and clinical decisions. If a separate tool materially changes these practices, you will receive any additional notice or consent required by law.
10 Alternatives and Right to Stop
Alternatives to telehealth may include an in-person consultation with the same or another provider, urgent care, an emergency room, laboratory or diagnostic testing, or the decision not to obtain care. You may ask questions or request an in-person evaluation at any time, although a specific in-person provider or service may not be available through Klarvia Health.
You may stop a telehealth consultation or withdraw this consent at any time by informing the clinician or contacting support@klarvia.health. Withdrawal applies prospectively and does not undo services already provided, does not affect records already created, and does not require deletion of information that must be retained by law. Withdrawing consent may prevent continuity of telehealth care.
11 Costs and Financial Terms
Charges, subscriptions, refunds, insurance or self-pay terms, pharmacy charges, and other financial terms are governed by the terms presented at checkout and Klarvia Health’s applicable policies, including the Refund and Cancellation Policy. This consent addresses the delivery of telehealth and does not, by itself, promise insurance coverage or reimbursement.
12 State-Specific Notices
Telehealth requirements vary by state. Depending on your physical location, the secure patient-care platform may present a state-specific notice or addendum before care. That notice or addendum is incorporated into this consent. If it conflicts with this general consent, the state-specific notice or addendum controls to the extent required by law.
13 Duration and Changes
This consent remains in effect for future telehealth consultations unless you withdraw it, it is replaced by a more recent consent, or applicable law requires a new consent. Klarvia Health or the Provider Group may update this consent to reflect changes in services or law. You will be asked to accept a new version when required.
14 Acknowledgment and Consent
By accepting electronically, I acknowledge and agree that:
- I have read and understood this Telehealth Informed Consent, or it has been read and explained to me in a manner I understand.
- I understand the nature of telehealth, its expected benefits, material risks, limitations, and reasonable alternatives.
- I understand that Klarvia Health does not provide medical care and that my care is provided by the Provider Group and the clinician identified on the secure patient-care platform.
- I have had the opportunity to ask questions and may ask additional questions before or during care.
- I voluntarily consent to receive telehealth care from the identified Provider Group and clinician.
- I intend my electronic acceptance and signature to have the same legal effect as a handwritten signature.
15 Record of Electronic Acceptance
The secure patient-care platform must record the following along with the accepted consent: the patient’s full legal name and verified account identifier; the state and physical location at the time of service; the Provider Group and clinician shown to the patient; the consent action through an affirmative checkbox or equivalent acceptance; the electronic signature or authenticated acceptance; and audit details, including date, time, policy version, and the technical audit log.
16 Contact Klarvia Health
For nonclinical questions about this consent or help accessing the secure patient-care platform, contact:
Klarvia Health
10601 Clarence Drive, Suite 250
Frisco, TX 75033
Email: support@klarvia.health
Website: www.klarvia.health
For questions about diagnosis, treatment, medications, or medical records, use the secure patient-care platform to contact the Provider Group or the clinician. Do not send emergency or detailed clinical information to the general support email.
