Hee Jin Cayetano

Physician Assistant Registered Dietitian

Trace Owens

Nurse
Practitioner

Veronica Marshall

Nurse
Practitioner

Zack Bernazzoli

Physician
Assistant

Telehealth Medical Consent

Last updated: February 15, 2025


EMERGENCIES AND URGENT NEEDS

OUR PROVIDERS DO NOT HANDLE MEDICAL EMERGENCIES. DO NOT USE THE EVOLVE ONE WELLNESS PLATFORM IF YOU BELIEVE YOU ARE HAVING A MEDICAL EMERGENCY. CALL 9-1-1 OR VISIT THE NEAREST EMERGENCY ROOM.

If you are contemplating suicide or experiencing a mental health crisis:

  • Dial 9-8-8 or text 9-8-8

  • Call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)

  • Visit 988Lifeline.org for live chat support


I. Introduction

By accessing or using telehealth services provided by EVOLVE YOUR BOD, you are agreeing to this Telehealth Informed Consent. These services are facilitated through our online platform, mobile app, or other telehealth technologies (collectively, the “Evolve Platform”). This document supplements, but does not override, the Terms of Use, Privacy Policy, or Notice of Privacy Practices associated with Evolve Your Bod and its healthcare providers (“Providers”).

By creating an account, beginning a consultation, clicking “I consent to telehealth,” checking a related box, or otherwise engaging with the Evolve Platform, you acknowledge and agree to the risks, limitations, and benefits of telehealth services as described herein.

Your continued use of the Evolve Platform and telehealth services signifies ongoing acceptance of this consent and any updates. Evolve Your Bod Providers include licensed and affiliated healthcare professionals responsible for delivering your care.


II. What is Telehealth?

Telehealth is a method of delivering healthcare services using electronic communication technologies to connect licensed healthcare providers with patients in remote locations. These services include consultations, diagnoses, treatment plans, follow-ups, and patient education. Telehealth can occur through various modalities, including synchronous (real-time video or audio), asynchronous (store-and-forward technology), or interactive audio with shared data. This enables you to receive medical care without visiting a physical office, providing greater convenience and flexibility. However, telehealth services are subject to specific limitations, which are detailed in this consent.


III. Benefits of Telehealth

Telehealth offers numerous benefits, including easier and more efficient access to healthcare services. By using telehealth, you can obtain medical care at times and locations that are convenient for you. This includes follow-up care, which can often be completed without the need for an in-office visit. Additionally, telehealth reduces the need for travel and minimizes disruption to your daily schedule. If you require further assistance or follow-up care, you can contact Evolve Your Bod at +1 866-301-3141 or via email at support@evolveyourbod.com during our business hours: Monday–Thurs, 8:00 AM–5:00 PM CST and Friday 8:00 AM–12:00 PM CST.


IV. Risks of Telehealth

While telehealth is a convenient and effective tool for many patients, it is not without its risks. Information transmitted electronically may not always be complete or sufficient for an accurate diagnosis or treatment plan. Your provider may determine that certain conditions are not suitable for telehealth and recommend in-person care. Technical issues such as internet disruptions, hardware malfunctions, or software failures may also delay or interrupt your consultation.

There is a risk that incomplete medical records or insufficient data could lead to incorrect treatment, adverse drug interactions, or allergic reactions. Diagnostic testing services, including lab work ordered via the Evolve Platform, are provided by third-party laboratories. These tests may occasionally produce false-positive, false-negative, or inconclusive results, potentially impacting your treatment plan.

You have the right to decline or discontinue telehealth services at any time. However, fees may still apply if a consultation has occurred. Evolve Your Bod and its affiliated Providers are not responsible for ensuring the continuity of care if you choose to terminate telehealth services.


V. Patient Acknowledgments

By consenting to telehealth services through Evolve Your Bod, you affirm the following:

  1. I have reviewed this Telehealth Informed Consent and understand the risks, benefits, and limitations associated with telehealth.

  2. I acknowledge the potential for privacy risks due to the electronic nature of telehealth services.

  3. My Provider may include nurse practitioners, physician assistants, or other licensed professionals.

  4. I understand others (e.g., tech support, translators) may be present during my session when necessary, and I will be informed of their roles.

  5. I agree that the information I provide during my telehealth sessions is accurate, truthful, and complete.

  6. My Provider may utilize asynchronous methods (e.g., store-and-forward technology) when appropriate, and I consent to this form of communication.

  7. Prescriptions are not guaranteed and are subject to the professional judgment of my Provider.

  8. I hold harmless Evolve Your Bod and its affiliates for any delays, errors, or information lost due to technical failures.

  9. I understand the risks associated with diagnostic testing and agree to use the recommended third-party laboratories, while acknowledging potential inaccuracies.

  10. Evolve Your Bod may not fulfill all healthcare needs, and I may need to seek additional resources or Providers.

  11. My messages and inquiries on the Evolve Platform may not be reviewed in real time, and I am responsible for regularly checking the platform for updates.

  12. I may withdraw my consent to telehealth services at any time, but understand this may limit my access to care through Evolve Your Bod.

  13. I have access to my medical records as required by applicable law and can share this information with my primary care provider or others with my consent.

  14. I can choose my preferred pharmacy or lab, regardless of Evolve Platform recommendations.

  15. I acknowledge that Evolve Your Bod is a third-party beneficiary of this Telehealth Informed Consent and reserves the right to enforce its terms.



VI. State-Specific Disclosures

Certain states require additional disclosures regarding telehealth services. If you are accessing the Evolve Platform for healthcare services, please note the following information specific to your state:

  • Iowa:

    As part of ensuring the highest standards of care, if you wish to express concerns or feedback about a provider’s service, you can find the appropriate resources on the Iowa Medical Board’s website. For more details, visit:

    Iowa Medical Board

    https://dial.iowa.gov/about-dial/boards-0/medicine

     

  • Kentucky:

    Patients are encouraged to provide feedback regarding their experiences. If you need to submit a formal comment or concern, guidance is available at the Kentucky Board of Medical Licensure. Learn more at:

    Kentucky Board of Medical Licensure

    https://kbml.ky.gov/grievances/Pages/default.aspx

  • Maine:

    We value transparency and patient satisfaction. If you feel the need to share any formal concerns, the Maine Board of Licensure in Medicine offers additional resources. Details are available at:

    Maine Board of Licensure in Medicine

    https://www.maine.gov/md/complaint/file-complaint

  • New York:

    Patients in New York have access to extensive resources regarding professional standards. If you require information about your rights or wish to provide formal feedback, visit:

    New York State Department of Health

    https://www.health.ny.gov/professionals/doctors/conduct/

  • Oregon:

    Feedback regarding healthcare services is essential for maintaining quality standards. Patients in Oregon who wish to provide formal input can find instructions at:

    Oregon Medical Board

    https://www.oregon.gov/omb/investigations/pages/how-to-file-a-complaint.aspx

  • Rhode Island:

    Transparency is a key component of quality care. Patients in Rhode Island seeking to address formal concerns about their providers can access more information at:

    Rhode Island Department of Health

    https://health.ri.gov/complaints/

  • Texas:

    Notice Regarding Complaints

    I acknowledge that I have been informed of the following:

    If you wish to file a complaint against a physician or any other licensed or registered healthcare professional regulated by the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants, you may submit your complaint for investigation at the following address:

    Texas Medical Board

    Attention: Investigations

    333 Guadalupe, Tower 3, Suite 610

    P.O. Box 2018, MC-263

    Austin, Texas 78768-2018

    For assistance in filing a complaint, please call 1-800-201-9353. Additional information and resources can be found on the Texas Medical Board’s website: www.tmb.state.tx.us

    .


    Aviso Sobre Quejas

    Reconozco que se me ha informado de lo siguiente:

    Si desea presentar una queja contra un médico u otro profesional de la salud con licencia o registrado ante el Consejo Médico de Texas, incluyendo asistentes médicos, acupuntores y asistentes quirúrgicos, puede enviar su queja para su investigación a la siguiente dirección:

    Consejo Médico de Texas

    Atención: Investigaciones

    333 Guadalupe, Torre 3, Suite 610

    P.O. Box 2018, MC-263

    Austin, Texas 78768-2018

    Para recibir asistencia con el proceso de presentación de quejas, llame al 1-800-201-9353. Para obtener más información, visite el sitio web del Consejo Médico de Texas en www.tmb.state.tx.us

    .

  • Vermont:

    Patients in Vermont who wish to provide feedback or register concerns have resources available through the Vermont Board of Medical Practice. Learn more at:

    Vermont Board of Medical Practice

    https://www.healthvermont.gov/systems/board-medical-practice/file-complaint

  • Wyoming:

    For patients in Wyoming, resources are available for those who wish to share feedback or concerns regarding healthcare services. Visit the Wyoming Board of Medicine at:

    Wyoming Board of Medicine. 

    https://wyomedboard.wyo.gov/consumers/file-a-complaint

 

VII. Contact Information

For additional questions, concerns, or support: Evolve Your Bod

1910 Fort Worth Highway, Weatherford, Texas 76086

Phone: 817-213-6205

Email:

support@evolveyourbod.com

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AA Health Solutions™, doing business as Evolve and Evolve Your Bod, is a patient management platform that partners with independent healthcare providers who deliver services through the Evolve Patient Engagement Platform. AA Health Solutions™ does not directly provide medical or pharmacy services, and payment does not guarantee the issuance or fulfillment of a prescription. All medical services are provided by independent practitioners. The information on this website is for informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. For any health-related questions or concerns, please consult with your healthcare provider. This website is an advertisement for services and is not intended to promote any specific medication.

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