Get Started

INFORMED CONSENT

Telehealth Informed Consent

VitalPeak Medical Services
Effective Date: December 16, 2025
Last Updated: December 16, 2025

Overview of Telehealth

Telehealth involves the use of secure electronic communications, information technology, or other means to enable a healthcare provider and a patient located in different places to communicate and share health information for the purpose of providing clinical care.

This Telehealth Informed Consent explains the nature of telehealth services, their potential benefits, limitations, and risks. Throughout this document, “you” or “patient” refers to the individual receiving services.

Services Provided

Telehealth services are provided by independent, licensed healthcare providers affiliated with or contracted through VitalPeak’s partner medical groups (collectively, the “Medical Group”) (each, a “Provider”).

Depending on clinical appropriateness, services may include:

  • Review of medical history and intake information

  • Consultation and evaluation

  • Diagnosis and education

  • Treatment recommendations

  • Prescriptions (if appropriate)

  • Referrals for in-person care

VitalPeak, Inc. does not provide medical care.
VitalPeak provides administrative, technical, and payment-related support for the Medical Group and Providers.

Electronic Communications

Telehealth services may involve electronic transmission of health information, including but not limited to:

  • Appointment scheduling

  • Completion and review of intake forms

  • Exchange of health records, images, videos, or other clinical data

  • Asynchronous (store-and-forward) communication

  • Two-way audio or audio-video interaction

  • Treatment recommendations and care plans

  • Consultation summaries or reports

  • Prescription or refill reminders

  • Billing and payment communications

Some information may be shared with third parties (e.g., pharmacies, labs) solely for the purpose of providing care.

Expected Benefits

Telehealth may provide benefits such as:

  • Convenient access to care without an in-office visit

  • More efficient follow-up and continuity of care

  • Reduced travel and wait times

  • Access to licensed providers regardless of location (where permitted by law)

Limitations of Telehealth

Because telehealth does not involve an in-person physical examination:

  • Certain conditions may not be appropriate for telehealth

  • Your Provider may determine that in-person care is necessary

🚨 Medical Emergencies
Telehealth services are not for emergencies.
If you believe you are experiencing a medical emergency, dial 911 immediately or go to the nearest emergency room.
If you are contemplating self-harm, call or text 988 (U.S. Suicide & Crisis Lifeline).

Telehealth providers do not replace your primary care provider. You are encouraged to maintain an ongoing relationship with a local primary care provider.

Security Measures

Telehealth services are delivered using systems designed to protect the confidentiality and integrity of your health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA).

Despite safeguards, no system is completely secure, and there is a small risk of unauthorized access.

Possible Risks of Telehealth

By consenting to telehealth, you acknowledge potential risks, including but not limited to:

  • Delays due to technology or provider availability

  • Poor image, audio, or data quality

  • Incomplete access to medical records, which could affect clinical decisions

  • Rare privacy breaches due to technical failures

  • The need to reschedule or transition to in-person care

If technical issues prevent communication, you may contact VitalPeak Support at:
Email: support@vitalpeak.com
Phone: [Insert Support Number]

Patient Acknowledgments

By consenting, you acknowledge and understand that:

  • You may review Provider credentials or request another available Provider

  • You may be asked to verify your identity and physical location

  • Telehealth services are conducted in English

  • You may withdraw consent for telehealth at any time without affecting future care

  • Telehealth records become part of your medical record

  • Your information may be shared with other healthcare professionals for treatment, payment, or care coordination

  • You may request copies of your medical records at a reasonable cost

You also understand that:

  • Prescriptions are not guaranteed

  • Providers exercise independent clinical judgment

  • You may choose your pharmacy

  • Providers may deny care if telehealth is not clinically appropriate or misuse is suspected

Third-Party Services & Testing

Certain services, such as laboratory testing, may be provided by third-party labs. Results may be inaccurate, incomplete, or inconclusive, and neither VitalPeak nor your Provider can guarantee their accuracy.

Presence of Additional Individuals

From time to time, technical or clinical support personnel may be present during a telehealth visit. You will be informed if anyone other than your Provider is present.

Accuracy of Information

You agree to provide complete, accurate, and current medical information. Failure to do so may result in termination of the patient-provider relationship or impact your care.

Privacy & Authorization

You consent to the use and disclosure of your health information as permitted by law for treatment, payment, and healthcare operations.

You authorize electronic prescribing systems and care coordination tools used by the Medical Group to access and transmit your health information as necessary.

State-Specific Notices

Certain states require additional disclosures or complaint procedures. Where applicable, you will be provided with state-specific notices related to your Provider and licensure.

Consent

By continuing, you acknowledge that you have:

  • Read and understood this Telehealth Informed Consent

  • Had the opportunity to ask questions

  • Voluntarily consent to receive telehealth services

Patient Consent Statement:
I acknowledge that I have carefully read, understand, and agree to the terms of this Telehealth Informed Consent and consent to receive telehealth services through VitalPeak.

DBA: VitalPeak Meds
119 Clifford St. Detroit, MI 48226
United States
support@vitalpeakmeds.com