Herexa Health Telehealth Consent

This Telehealth Informed Consent ("Consent") governs telehealth services provided by Herexa Health P.A. ("Herexa Health," "we," "our," or "us"). By submitting a medical intake questionnaire through our platform, you confirm that you have read, understood, and agreed to this Consent prior to receiving any clinical services.

IMPORTANT NOTICE

Telehealth services are provided by a physician licensed in the State of Florida and the State of New York. Services are available only to patients physically located in Florida or New York at the time of consultation. Consultation fee: $59 (medication costs are paid separately at your pharmacy). A medical record will be created and securely maintained for each telehealth encounter in compliance with applicable state and federal law.

1. What Is Telehealth

Telehealth involves the delivery of healthcare services using secure electronic communications technology, allowing a licensed physician to evaluate, diagnose, and treat patients without an in-person visit.

MODALITY DISCLOSURE — Asynchronous (Store-and-Forward) Technology

Herexa Health uses asynchronous telehealth technology, also known as "store-and-forward" delivery. This means you complete a secure online medical intake questionnaire, and a licensed physician reviews your submitted information and responds at a later time — not in real time. No live video call, audio call, or chat session occurs. This is the sole modality used for all consultations on this platform.

Your telehealth consultation involves the following steps:

You complete a secure, encrypted online medical questionnaire describing your symptoms and health history.
A board-certified OB-GYN reviews your submitted information using independent clinical judgment.
If clinically appropriate, the physician issues a prescription electronically to your preferred pharmacy. If not appropriate, you will be notified with guidance.
Follow-up communication, if needed, occurs through our secure messaging platform.

2. Physician Review and Treatment Decisions

All medical decisions at Herexa Health are made solely by a licensed physician using independent clinical judgment. The following apply to all consultations:

Submission of a medical intake questionnaire does not guarantee a diagnosis, treatment recommendation, or prescription issuance.
The physician may decline to prescribe if telehealth is not appropriate for your condition or if the submitted information is insufficient for a safe clinical decision.
Some conditions require in-person evaluation, physical examination, or laboratory testing that cannot be performed via telehealth. In such cases, you will be referred to in-person care.
Consultation fees are non-refundable once physician review of your intake has begun, regardless of whether a prescription is issued.

PRESCRIBING LIMITATIONS

In accordance with Florida law (§456.47(2)(c)) and federal law (21 U.S.C. §829), Herexa Health physicians may not prescribe Schedule II controlled substances (including opioids, stimulants such as Adderall, or benzodiazepines) via telehealth, with limited statutory exceptions that do not apply to this platform. Herexa Health treats only the specific conditions listed on our platform, and prescriptions are limited to medications clinically appropriate for those conditions.

3. Potential Benefits of Telehealth

Convenient access to licensed physician care from home or any private location within Florida or New York.
Elimination of travel time, waiting room delays, and scheduling barriers.
Same-day prescription review and issuance when clinically appropriate.
Private, HIPAA-secure communication without in-person contact.
Access to board-certified OB-GYN expertise for common women's health conditions.

4. Potential Risks and Limitations

Telehealth has inherent limitations compared to in-person medical care. By proceeding, you acknowledge the following risks and limitations:

General telehealth limitations:

The physician may not have access to your complete medical history, prior records, or prior laboratory results unless you provide them.
Technical failures (internet disruption, software error, platform outage) may interrupt or prevent your consultation.
Some medical conditions cannot be fully or safely evaluated without a physical examination, diagnostic imaging, or laboratory testing.
Telehealth may be less effective than in-person care for complex, urgent, or multi-system conditions.

Risks specific to receiving care at an off-site location (your home or other non-clinical setting):

Because you are located at home or another off-site location rather than a clinical setting, the physician cannot perform a physical examination, which may limit diagnostic accuracy.
If a medical emergency arises during or after your telehealth encounter, Herexa Health cannot provide direct emergency assistance. You must call 911 immediately.
You are responsible for ensuring a private, secure environment during your consultation to protect your own health information from unauthorized disclosure by third parties in your vicinity.
Environmental factors at your location (noise, poor lighting, connectivity issues) may affect the quality of care delivered.

FLORIDA-SPECIFIC DISCLOSURE (§456.47(2)(f))

In accordance with Florida law, telehealth services provided through Herexa Health may not be used to perform or facilitate an abortion, including medical abortions (as defined in §390.011, Florida Statutes), for patients located in Florida. Herexa Health does not provide abortion services.

5. Privacy, Confidentiality, and Recording

Your health information is handled in strict accordance with our Privacy Policy and applicable law, including the Health Insurance Portability and Accountability Act (HIPAA) (45 CFR Parts 160 and 164).

All communications transmitted through the Herexa Health platform are encrypted using industry-standard security protocols.
Your medical information is accessed only by authorized healthcare personnel involved in your care (including the reviewing physician and, where necessary, pharmacy staff for prescription fulfillment).
Your information will not be sold to third parties. Disclosure is limited to what is required for treatment, operations, and applicable legal obligations as described in our Privacy Policy.
A medical record will be created and securely maintained for each telehealth encounter in compliance with applicable state and federal law including Florida (§§395.3025(4) and 456.057) and New York (Public Health Law §2999-cc et seq.) law.

NO-RECORDING POLICY

Telehealth sessions, intake submissions, and communications conducted through Herexa Health will not be recorded, stored as audio or video, or shared beyond your treating physician and authorized staff without your explicit written consent. Your submitted health information is stored securely in our HIPAA-compliant systems. If recording is ever proposed for any purpose (such as quality assurance or training), you will be informed in advance and your separate written consent will be obtained.

While all reasonable technical safeguards are employed, no electronic system can be guaranteed completely secure against all possible unauthorized access. You accept this inherent limitation by using any electronic healthcare platform.

You have the following rights with respect to telehealth services provided by Herexa Health:

Right to refuse anytime or before care begins:

You have the right to refuse telehealth services at any time, including before your consultation begins, without penalty or negative consequence to any future care you may seek. Refusal of telehealth does not affect your right to seek care from an in-person provider.

Alternatives to telehealth:

If you choose not to use telehealth, you may seek care for your condition from an in-person healthcare provider in your area, including your primary care physician, an OB-GYN, an urgent care center, or a hospital outpatient clinic.

RISK OF DELAY — Please read:

Delaying or refusing telehealth care may result in a delay in receiving evaluation or treatment for your condition. For time-sensitive conditions (such as urinary tract infections, emergency contraception, or active herpes outbreaks), delay may affect clinical outcomes. If you choose not to proceed with telehealth, seek in-person care promptly.

Right to withdraw consent:

You may withdraw your consent to telehealth services at any time after care has begun by contacting Herexa Health at support@herexahealth.com or (727) 658-6565. Withdrawal of consent will prevent Herexa Health from providing further telehealth services to you under this Consent. Consultation fees already incurred are non-refundable per our Refund Policy.

If you are located in the State of New York at the time of your telehealth consultation, the following additional disclosures apply:

Right to request in-person care:

New York patients have the right to request an in-person evaluation at any time instead of or in addition to telehealth services.

Technology disclosure:

Telehealth services at Herexa Health are delivered via asynchronous secure text-based messaging and online medical questionnaires.

Confidentiality protections:

All existing patient confidentiality protections under New York law apply equally to telehealth encounters.

Your additional acknowledgments:

You understand the nature, benefits, risks, and limitations of telehealth services as described in this Consent.
You have had the opportunity to review this Consent before receiving care and to ask questions.
You are responsible for providing accurate, complete, and truthful health information. Providing false information may result in an incorrect clinical decision and termination of your access to the platform.
You understand that Herexa Health serves patients 18 years of age and older only.
You confirm that you are physically located in the State of Florida or the State of New York at the time of each consultation.

7. Emergency Situations

EMERGENCY NOTICE: Herexa Health is not an emergency medical service. If you are experiencing a medical emergency — including severe abdominal pain, heavy bleeding, chest pain, difficulty breathing, signs of stroke, or any other life-threatening symptom — STOP and call 911 immediately or go to your nearest emergency room. Do not use the Herexa Health platform to seek emergency care.

This page constitutes the reference version of the Herexa Health Telehealth Informed Consent. However, your legally documented consent is captured at the time of your intake submission through the following mechanism:

Before submitting your medical intake questionnaire, you will be required to check the following box:

"I have read and agree to the Herexa Health Telehealth Informed Consent. I understand the nature, benefits, risks, and limitations of telehealth services. I confirm that I am 18 years of age or older and am physically located in the State of Florida or New York at the time of this consultation. I understand I may refuse or withdraw consent at any time."

This confirmation is timestamped and stored in your patient record as required by Florida §456.47 and New York Public Health Law Article 29-G.

Continued use of the platform after reviewing this Consent additionally constitutes acceptance. If you do not agree to this Consent, do not submit a medical intake questionnaire.

Herexa Health may update this Telehealth Consent periodically to reflect changes in applicable law, platform capabilities, or clinical practice standards. Updated versions will be posted on this page with a revised effective date. For material changes, patients will be notified by email and required to re-acknowledge consent before their next consultation.

Continued use of telehealth services after posting of an updated Consent constitutes acceptance of the revised terms.