MyAshHealth

Telehealth Informed Consent

Last Updated: September 22, 2026

This Telehealth Informed Consent describes important information regarding healthcare services that may be provided through MyAshHealth and its affiliated or contracted healthcare professionals, medical groups, pharmacies, laboratories, technology providers, and other healthcare service partners.

Please read this Telehealth Informed Consent carefully before participating in any telehealth consultation, medical evaluation, treatment program, or other healthcare service made available through MyAshHealth.

By affirmatively providing your consent to receive telehealth services, you acknowledge that you have read, understood, and agreed to the terms described below.

1. What Is Telehealth?

Telehealth is the delivery of healthcare services through electronic communications and technologies when the patient and healthcare professional are located in different physical locations.

Depending upon the service and applicable law, telehealth may include:

  • Secure online medical questionnaires;
  • Asynchronous or "store-and-forward" medical evaluations;
  • Secure messaging with a licensed healthcare professional;
  • Telephone consultations;
  • Video consultations;
  • Electronic transmission and review of medical records, photographs, laboratory results, health information, and other clinical information;
  • Remote monitoring or other digitally enabled healthcare services; and
  • Follow-up communications regarding treatment, medications, testing, or ongoing care.

The specific form of telehealth used for your care will depend upon your medical needs, the healthcare professional's clinical judgment, available technology, and applicable federal and state requirements.

2. MyAshHealth's Role

MyAshHealth provides technology, administrative, and related services that facilitate access to healthcare services.

Healthcare services made available through the MyAshHealth platform are provided by appropriately licensed healthcare professionals or affiliated or contracted professional medical entities, as applicable.

MyAshHealth does not replace the independent professional judgment of a licensed healthcare professional. Clinical decisions, including whether treatment is appropriate, whether laboratory testing is necessary, what medication or treatment may be prescribed, and whether an in-person evaluation is required, are made by the treating healthcare professional.

Submitting information, purchasing a program, or requesting a consultation does not guarantee that a prescription, medication, laboratory order, or other treatment will be provided.

3. Consent to Receive Care Through Telehealth

I voluntarily consent to receiving healthcare services through telehealth.

I understand that my healthcare professional may evaluate my medical history, symptoms, current medications, allergies, laboratory results, photographs, health questionnaires, and other information that I provide electronically.

I understand that some telehealth encounters may occur asynchronously, meaning that I may not communicate with the healthcare professional in real time. The healthcare professional may review my submitted information and communicate with me later through secure electronic messaging or another approved method.

When clinically necessary or required by law, I may be asked to participate in a telephone, video, or in-person consultation before treatment can be provided.

4. Potential Benefits of Telehealth

Potential benefits of telehealth may include:

  • Increased access to healthcare professionals;
  • Greater convenience;
  • Reduced travel;
  • Faster exchange of medical information;
  • Ability to receive certain healthcare services from home or another private location;
  • Improved continuity and follow-up; and
  • Electronic access to healthcare information and communications.

I understand that these potential benefits are not guaranteed.

5. Risks and Limitations of Telehealth

I understand that telehealth has potential risks and limitations, including:

  • A healthcare professional may not have access to all information that would be available during an in-person examination;
  • Certain medical conditions cannot be appropriately diagnosed or treated through telehealth alone;
  • A healthcare professional may determine that an in-person examination, laboratory test, imaging study, emergency evaluation, or consultation with another healthcare professional is necessary;
  • Delays may occur because of technology failures, internet connectivity, equipment problems, or interruptions in electronic communications;
  • Electronic communications may occasionally be delayed, misdirected, or unavailable;
  • Despite reasonable privacy and security safeguards, electronic communications may involve privacy or cybersecurity risks;
  • Information provided by me may be incomplete, inaccurate, or insufficient to support a diagnosis or treatment decision; and
  • Treatment outcomes cannot be guaranteed.

I understand that I should provide complete and accurate medical information and promptly notify my healthcare professional of any significant changes in my medical condition.

6. No Guarantee of Prescription or Treatment

I understand that requesting a particular medication or treatment does not guarantee that it will be prescribed.

A licensed healthcare professional will independently determine whether a requested medication or treatment is medically appropriate based on my medical history, clinical information, applicable standards of care, professional judgment, and applicable law.

The healthcare professional may:

  • Approve the requested treatment;
  • Recommend a different treatment;
  • Request additional information;
  • Require laboratory testing;
  • Require a synchronous video or telephone consultation;
  • Recommend an in-person evaluation; or
  • Decline to prescribe or provide treatment.

I understand that prescriptions will only be issued when determined to be medically appropriate by an authorized healthcare professional.

7. Laboratory Testing

Some treatment programs may require laboratory testing before treatment begins or during treatment.

I understand that my healthcare professional will determine whether laboratory testing is clinically appropriate or required.

If laboratory testing is ordered, I may be directed to a third-party laboratory provider, such as an independent laboratory facility. Laboratory services may be subject to separate terms, privacy practices, charges, insurance rules, or consent requirements.

8. Medications and Pharmacy Services

If a healthcare professional determines that medication is appropriate, a prescription may be transmitted electronically to a pharmacy authorized to dispense the prescribed medication.

The pharmacy is responsible for dispensing and fulfilling prescriptions in accordance with applicable pharmacy laws and professional standards.

I understand that:

  • Prescription availability may vary by state;
  • Certain medications may not be available in every jurisdiction;
  • Pharmacy processing and shipping times may vary;
  • A prescription does not guarantee that a particular pharmacy will dispense the medication; and
  • The pharmacist may contact me or the prescribing healthcare professional if additional information is required.

9. Compounded Medications

Certain treatment programs may involve compounded medications when prescribed by a licensed healthcare professional and dispensed by an appropriately licensed compounding pharmacy.

I understand that compounded medications are prepared for individual patients based on a prescription and, unless otherwise expressly stated, compounded drugs are not FDA-approved in the same manner as commercially manufactured FDA-approved drugs.

My healthcare professional will determine whether a compounded medication is clinically appropriate for me.

10. Patient Responsibilities

To receive safe and appropriate telehealth care, I agree to:

  • Provide complete, current, and accurate information regarding my identity, medical history, medications, allergies, symptoms, and health conditions;
  • Notify my healthcare professional of relevant changes in my health;
  • Respond truthfully to medical questionnaires and clinical communications;
  • Follow reasonable treatment and follow-up instructions;
  • Complete laboratory testing when required;
  • Use prescribed medications only as directed;
  • Maintain the confidentiality and security of my MyAshHealth account;
  • Participate in telehealth encounters from a reasonably private environment when possible; and
  • Seek emergency or in-person medical care when appropriate.

11. Emergency Medical Conditions

MyAshHealth and its telehealth services are not intended for medical emergencies.

If I believe I am experiencing a medical emergency, I should immediately call 911 or go to the nearest emergency department.

I should not use electronic messaging, online forms, customer support, or the MyAshHealth platform for emergency medical conditions.

12. Privacy and Confidentiality

Healthcare information created, received, maintained, or transmitted in connection with telehealth services will be handled in accordance with applicable federal and state privacy requirements and applicable privacy practices.

Additional information regarding the collection, use, disclosure, and protection of information is available through the MyAshHealth Privacy Policy, HIPAA Notice of Privacy Practices, and other applicable privacy disclosures.

I understand that I should take reasonable precautions to protect my privacy when participating in telehealth encounters, including using secure devices and private locations when reasonably possible.

13. Identity and Location Verification

I understand that I may be required to provide information necessary to verify my identity.

I may also be required to confirm my physical location at the time healthcare services are provided because healthcare professionals generally must be authorized to provide care in the jurisdiction where the patient is physically located.

I agree to provide accurate information regarding my physical location when requested.

14. Technology Requirements and Interruptions

I understand that telehealth depends upon electronic systems, telecommunications networks, software, and internet connectivity.

Technical problems may occasionally interrupt or prevent a telehealth encounter.

If a telehealth encounter cannot be completed because of technical difficulties, the healthcare professional or support team may attempt to contact me through another approved communication method or may require that the encounter be rescheduled.

15. Record of Telehealth Care

Information relating to my telehealth evaluation and treatment may become part of my medical record.

Such information may include:

  • Medical questionnaires;
  • Clinical notes;
  • Secure messages;
  • Prescriptions;
  • Laboratory orders and results;
  • Treatment decisions;
  • Follow-up communications; and
  • Other information related to my healthcare.

Telehealth visits will not be recorded unless I am informed in advance and any consent required by applicable law is obtained.

16. Right to Ask Questions

I understand that I may ask questions regarding telehealth services before consenting or during my care.

If I do not understand a particular aspect of my treatment, medication, testing, or telehealth encounter, I should contact my healthcare professional through the appropriate secure communication channel.

Questions regarding billing, account access, shipping, or other non-clinical issues should be directed to MyAshHealth customer support.

17. Alternatives to Telehealth

I understand that telehealth is not my only option for receiving healthcare.

Depending upon my circumstances, alternatives may include:

  • An in-person visit with a physician or other healthcare professional;
  • An urgent care facility;
  • A primary care practice;
  • A specialist;
  • A hospital or emergency department; or
  • Another appropriately licensed healthcare provider.

I may choose to seek healthcare services elsewhere at any time.

18. Withdrawal of Telehealth Consent

I understand that, subject to applicable law and the status of care already provided, I may withdraw my consent to receive future telehealth services.

Withdrawal of telehealth consent will not affect the validity of healthcare services already provided or actions already taken based upon my prior consent.

Withdrawal may prevent MyAshHealth or participating healthcare professionals from continuing to provide services that require telehealth.

19. State-Specific Requirements

Telehealth laws and informed consent requirements vary by state.

Additional disclosures, notices, consent procedures, or healthcare professional requirements may apply based upon the state where I am physically located when healthcare services are provided.

When state law provides protections or requirements that differ from this Telehealth Informed Consent, applicable state law will control.

20. Separate Consent for Treatment, Payment, Privacy, and Communications

This Telehealth Informed Consent relates specifically to receiving healthcare through telehealth.

It is separate from:

  • MyAshHealth Terms of Use;
  • MyAshHealth Privacy Policy;
  • HIPAA Notice of Privacy Practices;
  • SMS/Text Messaging Terms and Consent;
  • California-specific privacy disclosures;
  • Payment authorization and financial terms; and
  • Any treatment-specific informed consent required by the healthcare professional.

Agreeing to website terms, privacy practices, marketing communications, or payment terms does not by itself constitute consent to receive telehealth healthcare services where separate consent is required by applicable law.

21. Acknowledgment and Consent

By selecting "START", signing electronically, or otherwise providing affirmative consent through the MyAshHealth platform, I acknowledge that:

  • I have read and understand this Telehealth Informed Consent;
  • I have had the opportunity to ask questions;
  • I understand the potential benefits, risks, and limitations of telehealth;
  • I understand that telehealth does not guarantee a prescription or particular treatment;
  • I understand that an in-person examination or additional testing may be required;
  • I understand that MyAshHealth is not intended for medical emergencies; and
  • I voluntarily consent to receiving healthcare services through telehealth.

I CONSENT TO RECEIVE TELEHEALTH SERVICES.