Medical Consent

1. Introduction

This document provides important information about telehealth services provided through Vionti Health. Please read this carefully and ask any questions before consenting to treatment.

2. What is Telehealth?

Telehealth involves the use of electronic communications to enable healthcare providers to deliver care remotely. This may include:

• Asynchronous messaging
• Phone consultations
• Remote monitoring
• Electronic transmission of medical records and prescriptions

3. Consent to Telehealth Services

By using Vionti Health's services, you consent to:

• Receiving healthcare services via telehealth technology
• Electronic transmission of your medical information
• Communication between healthcare providers regarding your care
• Receiving prescriptions electronically when medically appropriate

4. Benefits of Telehealth

• Improved access to healthcare without travel
• Convenient scheduling options
• Reduced exposure to illnesses in waiting rooms
• Ability to receive care from the comfort of your home

5. Risks and Limitations

While telehealth offers many benefits, there are potential risks and limitations:

• Technology failures may interrupt or prevent service delivery
• Security protocols may fail, potentially affecting the privacy of your information
• Lack of physical examination may limit diagnostic capability
• Delays in evaluation and treatment may occur due to technology issues
• The provider may determine that telehealth is not appropriate for your condition

6. GLP-1 Medication Information

If you are prescribed GLP-1 medication (semaglutide or tirzepatide), you understand and acknowledge the following:

Compounded Medications

• Compounded GLP-1 medications are produced in FDA-regulated facilities but are not FDA-approved products
• Results vary based on individual factors including adherence to treatment and lifestyle changes
• This medication should be used as part of a comprehensive weight management program

Contraindications

GLP-1 medications should not be used if you have any of the following:

• Personal or family history of medullary thyroid carcinoma (MTC)
• Multiple Endocrine Neoplasia syndrome type 2 (MEN 2)
• Known hypersensitivity to semaglutide, tirzepatide, or any excipients
• Pregnancy or planning to become pregnant
• Currently breastfeeding

Serious Side Effects and Risks

GLP-1 medications carry risks of serious adverse effects, including but not limited to:

• Pancreatitis (inflammation of the pancreas)
• Gallbladder disease, including gallstones
• Kidney injury, including kidney failure
• Serious allergic reactions (anaphylaxis, angioedema)
• Hypoglycemia, particularly when used with insulin or sulfonylureas
• Increased heart rate
• Suicidal thoughts or behavior (rare, under investigation)
• Intestinal obstruction (ileus)

Common Side Effects

Common side effects may include:

• Nausea
• Vomiting
• Diarrhea
• Constipation
• Abdominal pain
• Injection site reactions

You should report any adverse reactions to your healthcare provider immediately.

Drug Interactions

GLP-1 medications may interact with other medications, including:

• Insulin and sulfonylureas: Increased risk of hypoglycemia when used in combination
• Oral medications: GLP-1 medications slow gastric emptying, which may affect the absorption of other oral medications
• Oral contraceptives: May reduce effectiveness of oral birth control — discuss alternative or additional contraception methods with your provider

You must disclose all current medications, supplements, and over-the-counter drugs to your provider before starting treatment.

Pregnancy and Breastfeeding Warning

7. Alternative Treatments

Alternatives to GLP-1 medication for weight management include:

• Lifestyle modifications (diet and exercise alone)
• Behavioral therapy and counseling
• Other FDA-approved weight loss medications
• Bariatric surgery

The decision to use GLP-1 medication should be made collaboratively with your healthcare provider after discussing the risks, benefits, and alternatives relevant to your individual health profile.

8. Provider Relationship

Healthcare providers accessible through Vionti Health are independent licensed clinicians and are not employees of Vionti Health. They exercise independent medical judgment in all clinical decisions. Vionti Health provides the technology platform to facilitate the telehealth encounter. The doctor-patient relationship is established between you and the treating provider.

9. Recording and Documentation Consent

Telehealth encounters may be documented in your medical record. By using our services, you consent to the documentation of your consultation, treatment plans, and any related communications as part of your medical record.

10. Your Responsibilities

You agree to:

• Provide accurate and complete medical information
• Inform your provider of all medications you are currently taking
• Follow your treatment plan as prescribed
• Report any adverse reactions or concerns promptly
• Attend follow-up appointments as recommended
• Maintain a safe environment during telehealth sessions

11. Emergency Situations

Telehealth services are not intended for emergency situations. If you experience a medical emergency, please call 911 or go to the nearest emergency room immediately.

12. Right to Withdraw Consent

You may withdraw your consent to telehealth services at any time. Withdrawal of consent will not affect any services already provided.

13. Questions and Contact

If you have questions about this consent or our services, please contact us:

Email: support@viontihealth.com
Phone: (844) 357-3601