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Telehealth Informed Consent PBH Health LLC Effective Date: March 2022 PBH Health LLC (“PBH Health”) provides healthcare services using telehealth technologies. Telehealth allows licensed healthcare providers to evaluate, diagnose, and treat patients remotely using electronic communication technologies. By using PBH Health services, you acknowledge and agree to the following: 1. Nature of Telehealth Services Telehealth services may include: Secure video consultations Online medical questionnaires Remote monitoring and follow-up care Electronic prescribing where medically appropriate Communication via secure messaging or electronic platforms Telehealth services are provided by licensed healthcare professionals in accordance with applicable federal and state laws. 2. Potential Benefits of Telehealth Telehealth may provide several benefits, including: Increased access to healthcare services Reduced travel time and cost Greater convenience for follow-up care Faster access to clinical evaluation and treatment 3. Limitations of Telehealth Telehealth may have limitations compared with in-person medical visits. Potential limitations include: Technical failures or connectivity issues Limited ability to perform physical examinations Incomplete medical information provided by the patient Situations where in-person evaluation is medically necessary If a provider determines that telehealth is not appropriate, you may be referred for in-person medical care. 4. Privacy and Security PBH Health uses reasonable administrative, technical, and physical safeguards to protect the confidentiality and security of patient information in accordance with HIPAA and applicable privacy laws. However, electronic communication may carry some inherent privacy risks despite security measures. 5. Prescribing Through Telehealth Prescriptions may be issued only when: A licensed clinician determines that a prescription is medically appropriate All applicable federal and state prescribing regulations are satisfied The patient has provided accurate and complete medical information PBH Health does not guarantee that any medication will be prescribed. 6. Patient Responsibilities Patients are responsible for: Providing accurate medical history and health information Informing providers of current medications and allergies Following prescribed treatment plans Seeking emergency care when necessary Telehealth services are not intended for emergency medical situations. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room. 7. Consent to Telehealth Services By using PBH Health services, you acknowledge that: You have read and understand this Telehealth Informed Consent You understand the risks and benefits of telehealth You consent to receive healthcare services through telehealth technologies You may withdraw your consent for telehealth services at any time by discontinuing use of the service.

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