Telehealth Informed Consent

Effective Date: January 1, 2026

Please read this Telehealth Informed Consent carefully. It explains what telemedicine care with PainterMed, LLC (“PainterMed,” “the Practice”) involves, its benefits and limitations, and your rights. You will be asked to acknowledge that you have read and understand it before your consultation.

1. What Telehealth Is

Telehealth (telemedicine) is the delivery of health care using secure, real-time audio and video technology when you and your clinician are in different locations. At PainterMed, your consultation is a private video visit with Michael Painter, MMS, PA-C, conducted over Google Meet. No third parties are attached to or permitted to join your consultation.

Your telehealth care may include evaluation of your health history and current medications, discussion of your goals and concerns, and — where clinically appropriate — the design, prescription, monitoring, and adjustment of a personalized treatment protocol.

2. Eligibility and Location

To receive telehealth services, you must be at least 18 years old and physically located in the State of Florida at the time of your consultation. You agree to inform your clinician of your physical location at the start of the visit.

3. Benefits of Telehealth

Telehealth can make care more convenient and accessible by allowing you to consult with your clinician from a private location of your choosing, without travel or a waiting room, while maintaining a direct relationship with a single clinician.

4. Limitations and Risks of Telehealth

You should understand that telehealth has limitations:

A remote visit does not include a hands-on physical examination, and some conditions may require in-person evaluation, testing, or examination. If that is the case, your clinician will tell you and direct you to appropriate in-person care.

As with any technology, a video visit may be affected by technical problems such as poor connection, interruptions, or, in rare cases, security vulnerabilities despite reasonable safeguards.

Information transmitted may, in rare circumstances, be insufficient to allow for appropriate clinical decision-making, in which case your clinician may determine that telehealth is not appropriate for your situation.

As with all health care, results are not guaranteed, and individual responses to any treatment vary.

You understand that your clinician may determine that telehealth is not appropriate for some or all of your care and may recommend in-person evaluation or an alternative.

5. Compounded and Non-FDA-Approved Therapies

Some therapies that may be discussed or prescribed are compounded. Compounded therapies are not FDA-approved and are not reviewed by the FDA for safety, effectiveness, or quality before marketing. Your clinician will discuss the nature of any recommended therapy, its intended purpose, and relevant considerations so you can make an informed decision. Whether any therapy is appropriate for you is determined solely through clinical evaluation.

6. Not for Emergencies

Telehealth is not for medical emergencies. If you are experiencing an emergency, call 911 or go to the nearest emergency room. PainterMed does not provide emergency services, and communications are not monitored for emergencies.

7. Privacy and Confidentiality

Your telehealth visit and health information are protected under applicable federal and state privacy laws, including HIPAA, and are handled as described in our Privacy Policy & Notice of Privacy Practices. Visits are conducted over Google Meet, and no third parties are attached to your consultation. To protect your own privacy, you should participate from a private location where you will not be overheard.

We do not record your telehealth visit unless we obtain your separate consent. [CONFIRM whether visits are ever recorded; if never, this may be stated affirmatively.]

8. Your Rights

Your participation in telehealth is voluntary, and you may withhold or withdraw your consent at any time without affecting your right to future care or treatment.

You may ask questions about your care at any time and expect them to be answered in a manner you understand.

You have the right to be informed of alternatives to telehealth, including in-person care, and to request an alternative.

You may request that a telehealth visit be stopped at any time.

9. Financial Responsibility

Any fees, deposits, and payment terms applicable to your consultation or care are disclosed at the time of booking or during your visit. You are responsible for fees you agree to. [CONFIRM whether to reference specific fee/deposit terms here or direct to the booking disclosure only.]

10. Consent

By acknowledging this document, you confirm that:

You have read and understand this Telehealth Informed Consent, or have had it explained to you.

You have had the opportunity to ask questions and have them answered.

You understand the benefits, limitations, and risks of telehealth described above.

You are at least 18 years old and will be physically located in Florida during your consultation.

You voluntarily consent to receive care from PainterMed, LLC through telehealth.

11. Contact

Questions about telehealth care or this consent may be directed to:

PainterMed, LLC — Michael Painter, MMS, PA-C Phone: (954) 800-3290 Email: [email protected]

PainterMed provides concierge telemedicine to eligible patients in Florida.