Telehealth Informed Consent
Last updated: July 2026
Effective date: [EFFECTIVE DATE]
This Telehealth Informed Consent describes the nature of telehealth care provided through originshealth.com by physicians affiliated with [ORIGINS LEGAL ENTITY NAME] (“Origins Health”). Origins Health is a direct-to-consumer telehealth company that operates entirely online and has no physical clinic. Please read this consent carefully. By using our services, you acknowledge that you have read and understood it and that you consent to receive care by telehealth.
What Telehealth Is
Telehealth is the delivery of healthcare using secure electronic communication rather than an in-person visit. Through our platform, a licensed physician reviews the health questionnaire you submit and, where clinically appropriate, prescribes and manages therapy. Communication may take place through secure messaging and, where required, live consultation.
Benefits of Telehealth
- Access to licensed physicians without traveling to a physical location.
- Convenient, private evaluation from home on your own schedule.
- Ongoing management of therapy through secure communication.
Limitations of Telehealth
- Care is delivered without a hands-on physical examination.
- The physician relies on the accuracy and completeness of the information you provide.
- In rare cases, technology may fail or information may be insufficient, and the physician may recommend in-person care.
- Telehealth is not appropriate for emergencies. Call 911 or go to the nearest emergency room for urgent or emergency needs.
Physician Review
A licensed physician reviews your health questionnaire before any prescription is issued. The physician uses independent clinical judgment and may decline to prescribe, may request more information, or may recommend a different course of care. A physician-patient relationship is formed only after the physician has reviewed your information and agreed to provide care.
No In-Person Examination
You understand that care through Origins Health does not include an in-person physical examination and that this may limit the physician’s ability to evaluate certain conditions. You agree to provide complete and accurate information and to seek in-person care when appropriate.
Privacy and Records
Your health information is collected and stored on a HIPAA-compliant platform and handled as described in our Privacy Policy and HIPAA Notice of Privacy Practices. As with any electronic communication, there is a small risk of a privacy or security event, though we use reasonable safeguards to protect your information.
Your Right to Withdraw
Your participation in telehealth is voluntary. You may withhold or withdraw your consent to telehealth care at any time without affecting your right to seek care through other means. Withdrawing consent may end your ability to receive services through Origins Health.
Acknowledgment
By proceeding, you confirm that you are at least 18 years old, located in the United States, and that you understand and consent to the telehealth care described here.
Contact Us
[ORIGINS LEGAL ENTITY NAME]
[MAILING ADDRESS]
Email: [SUPPORT EMAIL]
Phone: [SUPPORT PHONE]