Telehealth Consent
Telehealth Consent
Fitish Telehealth Consent
Effective date: August 1, 2025
BY CLICKING "I AGREE," CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE,
USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE
OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE
THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF
YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE
SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON
THE "I AGREE" BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT
ON YOUR BEHALF.
IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION SUCH AS
CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988.
PURPOSE
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 Fitish, LLC (the "Service"). In this Consent, the
terms "you" and "yours" refer to the person using the Service.
USE OF TELEHEALTH
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, but is not limited to, one or more of the following: 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 (such as messaging or email communications); 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.
ANTICIPATED BENEFITS
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.
POTENTIAL RISKS
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 following: the quality, accuracy or effectiveness of the
services you receive from your Provider could be limited; technology, including the Service, may
contain bugs or other errors, including ones which may limit functionality, produce erroneous
results, render part or all of such technology, including the Service, unavailable or inoperable,
produce incorrect records, transmissions, data or content, or cause records, transmissions, data
or content to be corrupted or lost; failures of technology may also 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 in some cases prevent the Provider(s) from providing a
diagnosis or treatment or from identifying the need for emergency medical care or treatment for
you; your Provider(s) may not able to provide treatment for your particular condition and you
may be required to seek alternative healthcare or emergency care services; mental health
services may result in feeling worse as therapy progresses; delays in medical
evaluation/treatment could occur due to unavailability of your Provider(s) or deficiencies or
failures of the technology or electronic equipment used; the electronic systems or other security
protocols or safeguards used could fail, causing a breach of privacy of your medical or other
information; data stored and communicated electronically, for example, through email
communications, may be more susceptible to unintended disclosure of protected health
information to third parties; given regulatory requirements in certain jurisdictions, your
Provider(s) diagnosis and/or treatment options, especially pertaining to certain prescriptions,
may be limited; a lack of access to all of your medical records may result in adverse drug
interactions or allergic reactions or other judgment errors.
LIFE THREATENING AND OTHER EMERGENCY
SITUATIONS; FOLLOW-UP CARE
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. If you are not
experiencing an emergency or do not require immediate or urgent care, you can communicate
with Providers through the secure message service in the Service.
DATA PRIVACY AND PROTECTION
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 to disclose to other
persons and agencies certain information obtained during the provision of mental health
services (e.g., danger to self or others; mandatory reporting of child, elder, or vulnerable adult
abuse) or as otherwise set forth in your Provider's Notice of Privacy Practices. Use of the
Service may include email communications to and from you that may include your protected
health information. You understand that Fitish does not and cannot guarantee the security
or privacy of the services you use to receive communications, including for example your email
service provider.
YOUR ACKNOWLEDGMENTS
By clicking "I Agree", checking a related box to signify your acceptance, using any other
acceptance protocol presented through the Service or otherwise affirmatively accepting this
consent, you are agreeing and providing your consent with respect to the following:
Healthcare services provided to you by Providers via the Service will be provided by telehealth.
In some cases, your treating Provider may be a nurse practitioner or physician assistant and not
a physician, and you agree to be treated by non-physician providers, if applicable, by using the
Service. Your treating Provider for therapy services will be a mental health professional, such as
a licensed counselor. Certain technology, including the Service, may be used while still in a beta
testing and development phase, and before such technology is a final and finished product.
Technology used to deliver care, including the Service, may contain bugs or other errors,
including ones which may limit functionality, produce erroneous results, render part or all of such technology unavailable or inoperable, produce incorrect records, transmissions, data or content,
or cause records, transmissions, data or content to be corrupted or lost, any or all of which
could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or
other services that you receive from your Provider(s). Certain diagnostic testing services,
including laboratory products and services offered through the Service, may contain defects,
including ones which may limit functionality or produce erroneous results, any or all of which
could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or
other services that you receive from your Provider(s). The delivery of healthcare services via
telehealth is an evolving field and the use of telehealth or other technology in your medical care
and treatment from Provider(s) may include uses of technology different from those described in
this Consent or not specifically described in this Consent. No potential benefits from the use of
telehealth or other technology or specific results can be guaranteed, including any laboratory
testing results or related diagnosis or treatment by your Provider(s). Your condition may not be
cured or improved, and in some cases, may get worse. There are limitations in the provision of
medical care or other services and treatment via telehealth and technology, including the
Service, and you may not be able to receive diagnosis and/or treatment through telehealth for
every condition for which you seek diagnosis and/or treatment. There are potential risks to the
use of telehealth and other technology, including but not limited to the risks described in this
Consent. You have the opportunity to discuss the use of telehealth, including the Service, with
your Provider(s), including the benefits and risks of such use and the alternatives to the use of
telehealth. You understand that there will be no recording of any online treatment sessions by
your Provider(s) or you. Your Provider(s) will assess your medical condition and, in their sole
discretion, may determine it is medically appropriate to diagnose and/or treat your condition via
telehealth and whether you maintain sufficient knowledge and skills in the use of technology
appropriate to diagnosing and/or treating your condition via telehealth. By continuing to use the
Service, you concur with your Provider's medical assessment and agree to receive a diagnosis
and/or treatment via telehealth technology. You have the right to withdraw your consent to the
use of telehealth in the course of your care, without prejudice to any future care or treatment
and without risking the loss or withdrawal of any health benefits to which your entitled, but you
understand that the Providers who utilize the Service do not offer in-person treatment. Any
withdrawal of your consent will be effective upon receipt of written notice to your Providers,
except that such withdrawal will not have any effect on any action taken by Fitish or your
Provider(s) in reliance on this Consent before it received your written notice of withdrawal. Any
withdrawal of your consent will not affect any other provision of this Consent, and you will
continue to be bound by this Consent. You understand that the use of the Service involves
electronic communication to and from you of your personal medical information in connection
with the provision of telehealth services, including through email. You understand that it is your
duty to provide Fitish and your Provider(s) truthful, accurate and complete information,
including all relevant information regarding care that you may have received or may be receiving
from healthcare and/or mental health providers including emergency contact information for
your local healthcare and/or mental health providers. You understand that each of your
Provider(s) will assess your medical condition and, in their sole discretion, may determine it is
medically appropriate to diagnose and/or treat your condition using telehealth technology,
including the Service. By continuing to use the Service, you concur with your Provider's medical assessment and agree to receive a diagnosis and/or treatment via telehealth technology. You
understand that each of your Provider(s) may determine in their sole discretion that your
condition is not suitable for diagnosis and/or treatment using telehealth technology, including the
Service, and that you may need to seek care and treatment from a specialist or other healthcare
provider, outside of such telehealth technology.
Fitish, will use its pharmacy partners to fulfill your order directly to your door. You are free
to obtain your prescription from any pharmacy of your choice by contacting our support team
and notifying your prescribing healthcare professional directly using the Platform and your
secure messaging. Prescriptions may be filled by and transferred between any pharmacy
partners on your behalf. You must pay the full amount of the costs associated with use of the
Service, including any prescription you may receive, and you will not attempt to submit a claim
to Medicare, any other federal payor, or any state or private insurer.
If you have a concern about a medical professional, you may contact the Medical Board in your
state regarding your concerns.
Fitish does not provide doctor consultations, consultations are done through DrTelx.
CONTACT INFORMATION
If you have any questions or comments about this Telehealth Consent practices, please message us through the Platform or contact us at:
Fitish, LLC
2311 East Loop 820 North
Fort Worth, Texas 76118
TheClinic@Fitish.com