Please read this document carefully before your consultation begins
If you believe you are experiencing a medical emergency, do not use this platform. Instead:
Verum Health provides clinical infrastructure and care coordination services. We are not a healthcare provider or medical practice. Clinical services are delivered by independent, licensed healthcare providers operating through affiliated professional medical entities in the states where they are licensed. By using the Services and signing this consent, you are consenting to receive healthcare services from those independent providers — not from Verum Health.
Please read this document carefully. It describes what you can expect from your telehealth consultation, your provider's credentials, the benefits and risks of telehealth, and disclosures required under the laws of your state of residence. Some states require you to sign or acknowledge this document before your consultation may begin.
Your provider's license, credentials, and professional background are available through your patient profile prior to your consultation. If you have questions about your provider's credentials, please direct them to your provider before the consultation begins. State-specific information about how to verify provider credentials or file a complaint is included in the State Regulations section below.
Telehealth is the delivery of healthcare services through electronic communications between a licensed provider and a patient who are not in the same physical location. The platform uses encrypted communication protocols designed to protect the confidentiality and integrity of your health information.
Potential benefits include convenient access to licensed providers from your home, timely access to clinical evaluation and care management, and the ability to consult with specialists who may not be locally available.
Potential risks include technical failures — such as dropped connections or poor audio or video quality — that could affect the quality or continuity of the consultation. In rare circumstances, a provider may determine that the information transmitted is insufficient to complete a proper evaluation and may recommend an in-person visit or a rescheduled consultation.
In-person alternatives to telehealth are always available. Choosing telehealth does not prevent you from seeking in-person care at any time.
Controlled substances, including opioids, benzodiazepines, and stimulants classified under Schedules II–V of the Controlled Substances Act, are not available through this platform under any circumstances. If your clinical needs require a controlled substance, you must consult an in-person provider.
Your health information is confidential and handled in accordance with our Privacy Policy, Notice of Privacy Practices, and applicable federal and state laws. In limited circumstances, confidential information may be disclosed without your consent, including:
All services are provided on a cash-pay basis. We do not accept health insurance, Medicare, or Medicaid. Fees are due at the time of service. If you believe you have been charged incorrectly, notify us in writing at legal@verumhealthmed.com within 15 calendar days of the charge. Failure to notify us within this window constitutes acceptance of the charge.
Some services may require at-home diagnostic or laboratory tests provided by independent third-party laboratories. Neither Verum Health nor your provider can guarantee the accuracy or reliability of third-party laboratory results. Laboratory tests can produce false positive, false negative, or inconclusive results that may affect your provider's ability to make an accurate diagnosis or treatment recommendation.
By acknowledging this document electronically or signing below, you confirm that you understand and agree to the following:
The following disclosures are required under the laws and regulations of specific states. Please read the disclosure applicable to your state of residence at the time of your telehealth encounter.
Alabama: You understand that your provider may forward a copy of your medical records to your primary care physician. (Ala. Code § 34-24-503).
Alaska: Your primary care provider may obtain a copy of records from your telehealth encounter. (Alaska Stat. § 08.63.210(C)(2)).
Arizona: All medical records resulting from a telemedicine consultation are part of your medical record. (Ariz. Rev. Stat. Ann. § 36-3602(D)).
California: You have the right to withhold or withdraw consent to telehealth at any time without affecting your right to future care. All physicians practicing in California are licensed and regulated by the Medical Board of California. To verify a physician's license or file a complaint, visit www.mbc.ca.gov, email licensecheck@mbc.ca.gov, or call (800) 633-2322. (Cal. Bus. & Prof. Code § 2290.5; Cal. Welf. & Inst. Code Ann. § 14132.725(d)).
Colorado: You understand that your provider may share your health information as necessary to provide coordinated care, and that you have the right to access your telehealth records. (6 Colo. Code Regs. § 1011-3).
Connecticut: Your primary care provider may obtain a copy of records from your telehealth encounter, and you may revoke your consent at any time. (Conn. Gen. Stat. Ann. § 19a-906).
D.C.: You have been informed of alternate methods of communication with your physician for urgent matters. All relevant communications with the physician, including electronic communications, shall be documented and filed in your medical record. (D.C. Mun. Regs. tit. 17, §§ 4618.9–4618.10).
Delaware: You have been informed of the risks, benefits, and limitations of telemedicine, including the limitations of telemedicine in an emergency situation. (24 Del. Code § 1769D).
Florida: Patients prescribed GLP-1 medications for weight loss have been provided with the Florida Weight-Loss Consumer Bill of Rights. See Appendix below.
Georgia: You have been given clear and appropriate instructions on how to obtain emergent follow-up care if needed. (Ga. Comp. R. & Regs. 360-3-.07(7)).
Hawaii: You understand that your provider is required to document your telehealth encounter in your medical record in the same manner as an in-person encounter, and that you have the right to access those records. (Haw. Rev. Stat. § 453-1.3).
Idaho: To file a formal complaint about a provider, visit https://dopl.idaho.gov/filing-a-complaint/. Your informed consent for telehealth services will be obtained as required by applicable law. (Idaho Stat. § 54-5708).
Illinois: You have been informed of the right to request an in-person evaluation, and the provider has used clinically appropriate telehealth technology. (225 Ill. Comp. Stat. 60/49.5).
Indiana: If your provider issues a prescription, the prescriber will notify your primary care provider of any prescriptions issued unless: (A) your primary care provider has access to a shared electronic health record system; or (B) the prescriber has established an ongoing relationship with you through at least two prior telehealth encounters. Indiana Medicaid patients have the right to choose between in-person and telehealth care. (Ind. Code Ann. § 25-1-9.5-7).
Iowa: To file a complaint with the Iowa Medical Board, email ibmcomplaints@iowa.gov. Your provider will identify an in-person medical home or treating physician with whom telemedicine services can be coordinated when appropriate. (Iowa Admin. Code § 653-13.11).
Kansas: If you have a primary care provider, your telehealth provider is required to send a report of treatment rendered during this encounter to that provider within three business days. (Kan. Stat. Ann. § 40-2,212(2)(d)(2)(A)).
Kentucky: To file a formal complaint about a provider, visit https://kbml.ky.gov/board/Pages/default.aspx. Upon your request, your physician must share your medical record with your primary care physician and other relevant members of your care team. (Kentucky Board of Medical Licensure Opinion on Telemedicine, as amended September 15, 2022).
Louisiana: You have been informed of the role of any other healthcare providers who may be present during the consultation. (46 La. Admin. Code Pt XLV, § 7511).
Maine: To file a formal complaint about a provider, visit https://www.maine.gov/md/complaint/file-complaint. (Code Me. R. tit. 02-373 Ch. 11, § 3.).
Maryland: You understand that your provider must maintain a complete medical record of your telehealth consultation and provide you with a copy upon request. (Md. Code Ann., Health Occ. § 14-302.1).
Michigan: You understand that your provider must document the telehealth encounter in your medical record and that you have the right to access those records. (Mich. Comp. Laws § 333.16171).
Minnesota: You have been informed that you have the right to receive a summary of the telehealth visit, and that your provider may forward a copy of your medical records to your primary care provider. (Minn. Stat. § 62A.673).
Mississippi: You understand that your provider must maintain appropriate documentation of your telehealth visit and that you have the right to access your records. (Miss. Code Ann. § 83-9-351).
Missouri: You understand that your provider must document the telehealth encounter in your medical record consistent with the documentation required for in-person encounters. (Mo. Code Regs. Ann. tit. 20, § 2150-4.200).
Montana: You understand that the telehealth provider is subject to the same standards of practice as apply to in-person healthcare encounters, and that you have the right to access your medical records. (Mont. Code Ann. § 37-3-102).
Nebraska: If you are a Nebraska Medicaid recipient, you may refuse the telehealth consultation at any time without affecting your right to future care or any Medicaid benefits. You have the right to access all resulting medical records and no patient-identifiable information will be shared with researchers without your written consent. (Neb. Rev. Stat. Ann. § 71-8505; 471 Neb. Admin. Code § 1-006.05).
New Hampshire: Your telehealth provider may forward your medical records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d).
New Jersey: You have the right to request a copy of your medical information. Your medical information may be forwarded to your primary care provider or other treating provider of record. If you do not have a primary care provider, your telehealth provider may assist you in identifying one. (N.J. Rev. Stat. Ann. § 45:1-62).
New Mexico: You understand that your provider must maintain a medical record for your telehealth visit and that you have the right to access that record. (N.M. Admin. Code § 16.10.5.9).
New York: Patients prescribed GLP-1 medications for weight loss have been provided with the New York Weight-Loss Consumer Bill of Rights. See Appendix below. (N.Y. Gen. Bus. Law § 642).
North Carolina: You understand that the telehealth provider must establish a proper provider-patient relationship and that you have the right to receive a copy of your medical records upon request. (N.C. Gen. Stat. § 90-18.3).
North Dakota: You understand that your telehealth provider is subject to the same standard of care as would apply to an in-person encounter. (N.D. Cent. Code § 23-01-46).
Ohio: Your telehealth provider may forward your medical records to your primary care or treating provider. (Ohio Admin. Code § 4731-37-01(C)(4)).
Oklahoma: You understand that your provider must document the telehealth encounter in your medical record and that you have the right to access your records and to request a copy for your primary care provider. (Okla. Admin. Code § 435:10-7-14).
Oregon: To file a complaint about your provider, contact: Oregon Medical Board, 1500 SW 1st Ave., Suite 620, Portland, OR 97201-5847. Phone: 971-673-2702. Email: complaintresource@omb.oregon.gov. (ORS § 17-52-677.07).
Pennsylvania: You understand that your provider must maintain a complete medical record of your telehealth encounter consistent with in-person medical records requirements, and that you have the right to receive a copy of your records upon request. (49 Pa. Code § 16.95).
Rhode Island: If you communicate with your provider via email or text, you have been informed about applicable security measures including data encryption and password protection, as well as the potential privacy risks associated with electronic communications. (Rhode Island Medical Board Guidelines).
South Carolina: Your medical records may be shared with other treating healthcare practitioners as permitted by applicable law. We can assist you in identifying a primary care medical home upon request. South Carolina Medicaid beneficiaries may withdraw consent at any time. (S.C. Code Ann. § 40-47-37).
South Dakota: You have received disclosures regarding the delivery models and treatment limitations applicable to your care. Your provider has discussed the diagnosis and its evidentiary basis and the risks and benefits of available treatment options with you. (S.D. Codified Laws § 34-52-3).
Tennessee: Tennessee Medicaid recipients may request an in-person assessment prior to receiving a telehealth assessment. (TN Dept. of Mental Health and Substance Abuse Services, Office of Crisis Services Telecommunications Guidelines, p. 8 (2012)).
Texas: Your medical records may be transmitted to your primary care physician within 72 hours. (Tex. Occ. Code Ann. § 111.005). NOTICE CONCERNING COMPLAINTS: Complaints about physicians and other Texas Medical Board licensees may be directed to: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Complaint assistance: 1-800-201-9353. Website: www.tmb.state.tx.us.
Utah: You have the right to: (i) access, supplement, and amend your personal health information; (ii) contact your provider for ongoing care; (iii) obtain a copy of your medical record documenting the telemedicine services; and (iv) request transfer of your medical record to another provider. (Utah Admin. Code r. 156-1-602).
Vermont: You have the right to receive a follow-up consultation with your distant-site provider upon request. To file a complaint about a provider, visit http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint. (Vt. Stat. Ann. § 9361; Vt. Board of Medical Practice Policy on Telemedicine, March 1, 2023).
Virginia: You have been informed of security measures used in this telehealth encounter including data encryption, password-protected systems, and other authentication techniques, as well as residual privacy risks that may exist despite those measures. You agree to hold Verum Health and affiliated providers harmless for information lost due to technical failures and provide express consent to transmission of patient-identifiable information to third parties as necessary for your care. (Virginia Board of Medicine Guidance Document 85-12).
Washington: You have additional rights regarding your consumer health data under the Washington My Health My Data Act. Please review our My Health My Data Privacy Policy. You may withdraw consent to telehealth services at any time without affecting your right to future care. (RCW Chapter 70.372; Wash. Admin. Code § 246-922-790).
West Virginia: You understand that your telehealth provider must maintain a medical record for your visit consistent with in-person documentation requirements, and that you have the right to access and receive copies of those records. (W. Va. Code § 30-3-13a).
Wisconsin: You understand that your provider must document the telehealth encounter in your medical record and that you have the right to access your records upon request. (Wis. Stat. § 448.9645).
Wyoming: You understand that your telehealth provider is subject to the same standard of care as applies to in-person encounters, and that you have the right to access and receive a copy of your medical records. (Wyo. Stat. Ann. § 33-26-102).
For patients prescribed GLP-1 medications (including compounded or branded semaglutide or tirzepatide) for weight loss in Florida or New York, the following statutory disclosures apply:
By signing below or acknowledging electronically through the platform, you confirm that you have read and understood this document, have had an opportunity to ask questions, and freely give your informed consent to receive telehealth services from the independent licensed providers affiliated with Verum Health under the terms described herein.