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PATIENT CONSENT

Consent to Telehealth

Effective October 6, 2026

Telehealth is not for emergencies. Call 911 for a medical emergency or call or text 988 for a mental-health crisis.

By checking an acceptance box, clicking I Agree, signing electronically, or using telehealth services facilitated through VORA360, you acknowledge that you have read and voluntarily consent to this document.

1. Nature of Telehealth

Telehealth is healthcare delivered remotely through electronic communications and may include asynchronous questionnaires, secure messages, telephone, audio or video, images, laboratory information, records, and device-generated data. Independent licensed providers determine which method is appropriate and whether in-person care is needed.

2. Expected Benefits

3. Risks and Limitations

4. Your Responsibilities

You agree to provide truthful and complete identity, health, medication, allergy, pregnancy, and medical-history information; use a reasonably private location and secure device; follow provider instructions; report adverse effects; and seek urgent or in-person care when directed.

5. Prescriptions and Pharmacies

A licensed provider independently determines whether medication is clinically appropriate. A prescription may be sent to a participating pharmacy or another permitted pharmacy. Availability, formulation, shipping, and pharmacy services vary. Compounded medications are not FDA-approved.

6. Privacy and Records

Information may be used and disclosed for treatment, payment, healthcare operations, fulfillment, and other permitted purposes. Telehealth records may become part of your medical record. Sessions will not be recorded unless notice and any legally required consent are provided.

7. Alternatives and Withdrawal

You may ask about alternatives, including in-person care, and may withdraw consent by written notice. Withdrawal does not affect prior actions and may make remote services unavailable.

8. Acknowledgment

You confirm that you understand telehealth benefits, risks, limitations, and alternatives; had an opportunity to ask questions; consent to care by licensed providers electronically; and authorize necessary coordination with clinicians, pharmacies, laboratories, and service providers.

Contact VORA

VORA RX, INC.
336 N. Superior St., Suite 1
Toledo, Ohio 43604
support@vora360.fit