Updated: May 1, 2026
The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare services to you by physicians, physician assistants, nurse practitioners (“Providers”) using the online platforms owned and operated by EOS Health, LLC (the “Service”). In this Consent, the terms “you” and “yours” refer to the person using the Service.
Telehealth involves the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education, and may include electronic transmission of medical records, photo images, personal health information or other data between a patient and a provider; interactions between a patient and provider via audio, video, and/or data communications; and use of output data from medical devices, sound and video files.
Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. Always discuss alternative options with your Provider.
The use of telehealth may have the following possible benefits: making it easier and more efficient for you to access medical care or other services and treatment for the conditions treated by your Provider(s); allowing you to obtain medical care or other services and treatment by Provider(s) at times that are convenient for you; and enabling you to interact with Provider(s) without the necessity of an in-office appointment.
While the use of telehealth in the delivery of care can provide potential benefits for you, there are also potential risks associated with the use of telehealth and other technology. These risks include, but may not be limited to: the quality, accuracy, or effectiveness of the services you receive could be limited; technology may contain bugs or other errors which may limit functionality, produce erroneous results, or render the Service unavailable; failures of technology may impact your Provider(s)’ ability to correctly diagnose or treat your condition; the inability of your Provider(s) to conduct certain tests or assess vital signs in-person may prevent the Provider(s) from providing a diagnosis or from identifying the need for emergency medical care; your Provider(s) may not be able to provide treatment for your particular condition; delays in medical evaluation or treatment could occur due to unavailability of your Provider(s) or deficiencies or failures of the technology; and the electronic systems used could fail, causing a breach of privacy of your medical or other information.
If you are experiencing a life-threatening situation such as contemplating suicide, call 911 or the 988 Suicide and Crisis Lifeline at 988.
If the situation is an emergency, call 911. In some situations, telehealth is not an appropriate method of care. If you require immediate or urgent care, you must seek care at an emergency room facility or other provider equipped to deliver urgent or emergent care. Providers may not respond promptly to communications you submit through the Service.
The electronic systems used in the Service will incorporate network and software security protocols to protect the privacy and security of your information and will include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your consent, except as authorized by law for the purposes of consultation, treatment, payment/billing, certain administrative purposes, and as required by law.
Use of the Service may include email communications to and from you that may include your protected health information. You understand that EOS Health does not and cannot guarantee the security or privacy of the services you use to receive communications, including your email service provider.
By clicking “I Agree”, checking a related box to signify your acceptance, or otherwise affirmatively accepting this consent, you are agreeing and providing your consent with respect to the following: