Telehealth Informed Consent

Telehealth involves the delivery of healthcare services using electronic communications, information technology, and other means between a healthcare practitioner and a patient who are not in the same physical location. AvataCore provides a technology and care coordination platform — clinical services are provided by independent licensed healthcare providers through our clinical partner's provider network.

Telehealth services through AvataCore may include: asynchronous review of health intake forms and questionnaires, secure patient-provider messaging, clinical evaluation for GLP-1 medication eligibility, prescription issuance (when clinically appropriate), and ongoing care check-ins. All consultations are conducted via HIPAA-compliant digital platforms.

Provider Qualifications:All healthcare providers accessible through AvataCore's platform are independent licensed professionals (physicians, nurse practitioners, or physician assistants) who are licensed to practice in your state of residence. Providers are credentialed through our clinical partner's provider network. AvataCore does not employ these providers; they exercise independent clinical judgment.

As with all medical care, there are potential benefits and risks associated with telehealth. Your provider will use professional judgment to determine whether telehealth is appropriate for your specific situation.

To receive safe and effective telehealth care, I understand and agree to the following responsibilities:

• Accurate Health Information: I will provide complete, accurate, and honest health information including all current medications (prescription and over-the-counter), supplements, allergies, medical conditions, surgeries, and relevant family history. I understand that providing false or incomplete information could result in inappropriate care and/or immediate termination of services.
• Follow-Up with Primary Care Provider (PCP): I understand that telehealth through AvataCore does not replace a comprehensive relationship with a primary care provider. I agree to maintain regular care with a PCP and to inform my PCP of all treatments I receive through AvataCore.
• Reporting Changes: I will promptly notify my provider through the patient portal of any new symptoms, side effects, medication changes, or significant health changes that occur during treatment.
• Safe Environment: I will participate in telehealth visits from a private, safe location where I can communicate freely and confidentially.
• Medication Compliance: I will take all prescribed medications exactly as directed, store them according to instructions, and not share them with any other person.
• Technology: I am responsible for having a compatible device, stable internet connection, and functional camera/microphone for video consultations when required.

AvataCore protects your health information in accordance with HIPAA, the HITECH Act, and applicable state privacy laws. All consultations and health data are transmitted using encrypted, HIPAA-compliant systems. AvataCore acts as a HIPAA Business Associate to the independent healthcare providers who serve you.

Your protected health information (PHI) will be shared with: (1) the independent licensed provider(s) evaluating you; (2) licensed compounding pharmacies necessary to fill your prescription; (3) other service providers under HIPAA Business Associate Agreements. Your PHI will not be sold, shared with advertisers, or used for non-treatment purposes.

Your Rights: You have the right to access your medical records, request corrections, request an accounting of disclosures, and receive a copy of this signed consent at any time. To make a records request, contact admin@avatacore.com.

Please review our full Privacy Policy for complete details on data collection, use, and your rights.

Compounded Medications: GLP-1 medications (semaglutide, tirzepatide) provided through AvataCore are compounded by licensed compounding pharmacies. Compounded medications are not individually FDA-approved, though the active pharmaceutical ingredients are FDA-recognized compounds. Compounded medications may differ in formulation, concentration, or delivery method from commercially available brand-name products.

Drug Interactions: GLP-1 medications may interact with oral medications, particularly those requiring rapid GI absorption (e.g., oral contraceptives, antibiotics). Disclose all medications and supplements to your provider.

No Outcome Guarantees: Individual results vary significantly. Weight loss outcomes are not guaranteed and depend on adherence, lifestyle factors, metabolism, and individual physiology. Clinical trials demonstrated average weight loss of 15–22%, but individual outcomes may be substantially higher or lower, including no meaningful weight loss.

Dosing & Safety: I agree to follow my prescribed dosing protocol exactly as directed, store medication as instructed (refrigeration requirements apply), and not share my medication with any other person. I will report adverse effects to my provider promptly.

All medical records created through your use of AvataCore's platform — including provider notes, intake questionnaires, and prescription records — are your health records. You have the following rights regarding your records:

• Right to Access: You may request a copy of your complete medical records at any time by contacting admin@avatacore.com. We will provide records within 30 days of a written request.
• Right to Correction: You may request that inaccurate information in your records be corrected.
• Right to Share: You may authorize us to share your records with any third party (such as your primary care provider) by submitting a written authorization.
• Right to Restrict: You may request restrictions on certain uses or disclosures of your records, subject to applicable law.

Records are retained for a minimum of 7 years from last date of service, consistent with HIPAA and applicable state medical records laws. Records are stored on HIPAA-compliant, encrypted infrastructure.

Continuity of Care: With your permission, we can share your treatment records with your primary care provider to ensure continuity of care. We strongly encourage this practice for your overall health safety.

Auto-Renewal:My subscription will automatically renew at the end of each billing period (monthly, quarterly, or annual) at the then-current rate. I authorize AvataCore’s clinical fulfillment partner (merchant of record) to charge my payment method on file on a recurring basis until I cancel.

Cancellation: I may cancel my subscription at any time through the patient portal or by emailing admin@avatacore.com. To avoid being charged for the next billing cycle, my cancellation request must be received at least 72 hours before my next billing date. Cancellation takes effect at the end of my current billing period.

Right to Withdraw Consent: I understand that I have the right to withdraw this telehealth consent at any time, without penalty. Withdrawal of consent means I am discontinuing telehealth services. Withdrawal does not affect care I received prior to withdrawal, and it does not prevent me from seeking traditional in-person care. To withdraw consent, I should contact admin@avatacore.com.

Refunds: If a provider determines I am ineligible for GLP-1 therapy, I will receive a full refund. Otherwise, refunds are only available if my medication for the current billing cycle has not yet been ordered by the pharmacy. Once medication has been ordered, subscription fees for that cycle are non-refundable. Full details are in the Cancellation & Refund Policy.