Telehealth Consent

Last Updated: August 18, 2026

What Telehealth Means

Telehealth allows you to receive healthcare services from a licensed healthcare professional without being physically present in the same location as the provider. Depending on the circumstances, your consultation may use secure video, audio, electronic questionnaires, messaging, or other technology approved for the service being provided.

Nova GLP-1 provides administrative and technology-related support for the program. The licensed healthcare provider participating in your care operates independently from Nova GLP-1 and is responsible for your medical evaluation, treatment recommendations, and prescribing decisions. Nova GLP-1 does not control the provider’s clinical judgment.

Telehealth is intended to provide access to healthcare when the provider determines that your condition and circumstances can appropriately be evaluated and managed using telehealth.

Potential Advantages of Telehealth

Telehealth may make it easier to communicate with a licensed healthcare professional without traveling to a medical office. It can also provide a convenient way to discuss your medical history, current health concerns, treatment options, and follow-up needs with your healthcare provider.

The provider will determine whether telehealth is an appropriate method for evaluating and treating you. If the provider determines that an in-person examination, testing, or another form of evaluation is necessary, you may be directed to obtain that care before treatment is initiated or continued.

Limitations and Potential Risks

As with any method of receiving healthcare, telehealth has limitations and potential risks. Information available to the provider through a remote encounter may be incomplete and could affect the provider’s ability to make a clinical assessment.

Technical problems, including interruptions in internet, audio, video, or other communication systems, may interfere with a consultation.

There is also a possibility that information transmitted electronically could be accessed by an unauthorized person despite reasonable security measures. Although safeguards are used to protect your information, no electronic communication system can be guaranteed to be completely secure.

Telehealth may also limit the provider’s ability to perform a hands-on physical examination or obtain certain information that would ordinarily be available during an in-person visit. In some circumstances, the provider may determine that additional testing, an in-person examination, or evaluation by another healthcare professional is appropriate.

Your Consent to Telehealth

By consenting to telehealth services, you acknowledge that you have been informed that healthcare may be provided through electronic communication and that you understand the general benefits, limitations, and risks associated with receiving care in this manner.

You understand that you may decline telehealth services or withdraw your consent, subject to applicable law and any circumstances in which the provider has already taken action based on your consent. You may also discuss other available methods of obtaining healthcare with your provider.

You understand that your provider will determine whether telehealth is clinically appropriate for your individual circumstances and may discontinue a telehealth encounter or recommend an in-person evaluation when the provider believes that additional care is necessary.

You understand that the use of telehealth does not guarantee a particular diagnosis, prescription, treatment, weight-loss result, or other outcome.

Communication and Medical Records

Information obtained during your telehealth encounters may be documented in your medical record and maintained in accordance with applicable federal and state privacy and medical-record requirements.

You may request access to your medical information as permitted by applicable law. You should also provide your healthcare provider with accurate and complete information about your medical history, medications, allergies, diagnoses, and other healthcare providers involved in your care.

Providing complete and accurate information is important because your provider’s clinical decisions may depend on the information you provide.

Privacy and HIPAA

Where applicable, your protected health information will be handled in accordance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and other applicable federal and state privacy requirements.

Reasonable administrative, technical, and physical safeguards are used to protect health information. However, you understand that electronic communications involve some risk of unauthorized access despite the security measures used.

Your healthcare provider’s applicable Notice of Privacy Practices explains in greater detail how protected health information may be used and disclosed and describes your rights concerning that information.

Information Shared With Other Healthcare Professionals

For purposes of providing appropriate care, your healthcare provider may need to communicate with other healthcare professionals involved in your treatment, particularly when coordination of care is medically appropriate or necessary.

You agree to provide accurate information regarding other physicians, healthcare professionals, medications, and treatments relevant to your care.

Prescriptions and Treatment Decisions

A telehealth consultation does not guarantee that a prescription will be issued.

The licensed healthcare provider independently determines whether medication or other treatment is medically appropriate. The provider may decline to prescribe a medication, may request additional information or testing, or may recommend an alternative treatment or an in-person evaluation.

Nova GLP-1 does not make independent medical decisions, determine medical eligibility, select medications, establish dosages, or direct a healthcare provider’s prescribing decisions.

Financial Responsibility

You understand that fees associated with the program and any applicable healthcare services are your responsibility unless otherwise stated in writing.

If you authorize recurring payments, your payment method may be charged according to the subscription or payment terms presented to you when you enroll.

You are responsible for maintaining accurate payment information and for amounts properly charged for services or products you have authorized.

Any cancellation, refund, or subscription terms applicable to your purchase are governed by the applicable Terms of Service and other enrollment disclosures.

Prescription Medication and Shipping

If a licensed healthcare provider determines that prescription medication is appropriate and issues a prescription, the prescription may be sent to an appropriately licensed pharmacy for dispensing.

Prescription medications are dispensed and shipped in accordance with applicable federal and state requirements. Shipping times may vary because of pharmacy processing, carrier delays, weather, address issues, regulatory requirements, or other circumstances outside Nova GLP-1’s control.

Nova GLP-1 does not independently make the clinical decision to prescribe medication and does not control the dispensing decisions of an independent pharmacy.

You are responsible for providing an accurate and complete shipping address and for promptly reporting any suspected delivery problem, damaged package, missing medication, or other medication-related concern.

Your Acknowledgment

By providing consent to telehealth services, you acknowledge that:

• You have had an opportunity to review and ask questions about receiving healthcare through telehealth.
• You understand that telehealth has both benefits and limitations.
• You understand that technology failures or other circumstances may interfere with a telehealth encounter.
• You understand that your healthcare provider may determine that telehealth is not appropriate for a particular medical issue.
• You understand that an in-person examination or additional testing may be recommended when clinically necessary.
• You understand that no particular medical result, weight-loss result, prescription, or treatment outcome is guaranteed.
• You agree to provide truthful, complete, and current information to your healthcare provider.
• You understand that your healthcare provider is independently responsible for medical evaluation, diagnosis, treatment recommendations, and prescribing decisions.
• You understand that Nova GLP-1 does not replace your primary care physician or other healthcare professionals involved in your care.
• You understand that you should seek appropriate in-person or emergency medical care when telehealth is not sufficient for your needs.

By continuing with the telehealth process, you confirm that you have read and understood this consent and voluntarily agree to receive healthcare services through telehealth when your licensed healthcare provider determines that telehealth is appropriate.