Telehealth Informed Consent

1 Please review this before receiving care

Telehealth means receiving healthcare through communications technology when you and your clinician are in different places. This document explains your choices, the limitations of remote care, and how TeleHeadache works. Please read it and ask questions before deciding. You may save or print a copy.

TeleHeadache is not an emergency service. For sudden severe headache, new weakness, trouble speaking, loss of consciousness, or another possible emergency, call 911 or go to an emergency department now. Do not wait for an assessment or message to be reviewed.

This public page describes the consent. Visiting it, opening an account, or paying for membership does not by itself constitute your telehealth consent. Consent is obtained separately through our secure enrollment process.

2 Our service and your clinician

TeleHeadache offers headache evaluation and ongoing care for eligible adults age 18 and older. Services may include a structured assessment, clinician review, secure messages, treatment planning, scheduled video visits, noncontrolled prescribing, headache tracking, and medication-access coordination.

TeleHeadache LLC provides the platform, related administrative services, and clinical care through qualified professionals. The clinician responsible for your clinical decision will be identified in your care record. Clinicians must be authorized to provide the applicable care where you are located.

Clinician assignment depends on authorization, scope of practice, availability, and your needs. A particular founder, neurologist, or the same clinician at every encounter is not guaranteed. Administrative staff and automated tools do not independently make your diagnosis or prescribe medication.

3 How asynchronous care works

Most routine TeleHeadache care begins with information you submit for later review. After free basic eligibility screening, you complete secure membership enrollment and payment before the full clinical assessment, which is included in membership. You provide your headache history and other relevant information. A licensed clinician independently reviews it and may ask more questions, make a clinical assessment, recommend treatment, or direct you to another service.

There is no live conversation during ordinary asynchronous review. A licensed clinician reviews your completed assessment within 24 hours. The 24-hour period starts when your completed initial assessment is successfully submitted. This timeframe applies to clinician review; it does not guarantee a diagnosis, prescription, medication availability, or delivery within that period. Unexpected technical or service interruptions may affect timing. Do not wait for review if you need urgent or emergency care. Nonurgent clinical messages are generally answered within one business day, Eastern Time.

Submitting a question, refill request, or headache entry does not mean a clinician has already read it. An automatic acknowledgment confirms receipt only. If your condition worsens or you need faster care, seek appropriate local evaluation rather than waiting for us.

4 Video visits and connection problems

You may request a scheduled video visit, and a clinician may require one before making or continuing a treatment decision. Video can support discussion and limited observation; it does not provide all the examination capabilities of an office visit. A video visit cannot replace emergency care or a necessary in-person examination.

For live care, we confirm your identity, actual location, and callback number. Use a private setting and do not participate while driving. If disconnected, follow the agreed reconnection instructions and check the portal. If you have emergency symptoms, call 911 rather than trying to reconnect.

Telephone-only care is not guaranteed. A clinician may use it only when the service supports it and it is legally and clinically appropriate. Otherwise, the visit may need to be rescheduled or redirected.

5 Potential benefits and important limits

Telehealth can reduce travel, allow you to submit history on your schedule, and support access to follow-up. These benefits and clinical improvement are not guaranteed.

Remote care also has limitations. A clinician cannot physically examine you through a questionnaire and may be unable to perform a complete neurologic examination, inspect your eyes adequately, measure vital signs directly, or obtain imaging and laboratory tests remotely. The information you provide may be incomplete, misunderstood, or inaccurate. A serious or different condition can be missed or recognized later.

Technology can fail. Messages, images, prescriptions, or video may be interrupted, delayed, incomplete, or unavailable. Electronic information could be accessed or disclosed improperly despite safeguards. Your environment, device, account security, and the people around you affect privacy.

The clinician may require records, additional questions, video, testing, specialist evaluation, or in-person care. Your case may be unsuitable for TeleHeadache. Consent does not require a clinician to use a modality that the clinician considers inadequate or unsafe.

6 Alternatives and your choice

Alternatives include an office visit with a primary-care clinician, neurologist, or other appropriate professional; another telehealth service; and urgent or emergency evaluation when appropriate. You may choose another provider or decline a proposed treatment. Delaying or declining care may allow a condition to worsen; discuss questions about your options with a qualified clinician.

You can ask questions about telehealth, the proposed treatment, its risks, expected benefits, and reasonable alternatives. This general consent does not replace a treatment-specific discussion or additional consent when required.

7 Where you are physically located

TeleHeadache provides care to eligible patients physically located in Florida. Your mailing address, pharmacy address, or insurance address does not establish your current location.

Give accurate location information when submitting a clinical assessment, requesting care or a refill, and beginning a video visit. Tell us if you travel or move while a request is pending. We may need to reconfirm your location before a clinical decision is made. Do not use an old address or another person's location to obtain care.

If you are somewhere we cannot lawfully provide the needed service, we may pause that service and direct you to local care. Do not assume that an existing membership makes care available in every state or country.

8 Emergencies and urgent concerns

Call 911 or obtain emergency evaluation for a sudden or unusually severe headache, new facial droop, weakness, speech difficulty, seizure, major confusion, loss of consciousness, severe allergic reaction, or other potentially life-threatening symptoms. A headache with fever and marked neck stiffness, or concerning symptoms after a head injury, also needs immediate evaluation. This is not a complete list.

During pregnancy or in the year after delivery, a severe or worsening headache, persistent headache, or vision changes may be an urgent warning sign. Seek medical attention immediately; use 911 for severe symptoms or a possible emergency.

The assessment, tracker, email, text messages, support desk, and patient portal are not emergency-response services. Safety questions and alerts cannot identify every emergency. We may contact emergency services or an emergency contact when appropriate and legally permitted, but do not rely on us to locate you or dispatch help. Provide accurate contact and location information and follow immediate-care instructions.

9 Prescribing treatment and follow up

A clinician determines whether a diagnosis, prescription, treatment change, or refill is appropriate. None is guaranteed by payment, consent, a questionnaire result, or a previous prescription. TeleHeadache does not prescribe controlled substances and does not offer opioids or barbiturate-containing headache medication. Purchasing video does not create an exception.

Tell the clinician about all prescription and nonprescription medicines, supplements, allergies, relevant conditions, prior reactions, and pregnancy, breastfeeding, or plans for pregnancy. Medications have benefits and risks, including interactions and side effects. Follow the individualized instructions and ask about anything unclear. Do not change another clinician's medication solely because of general website information.

Refills require clinical approval and may require current information, follow-up, location confirmation, video, or outside evaluation. Request them with adequate time before running out. Membership renewal does not automatically authorize a refill. Share important changes in symptoms or health and maintain other care you need.

10 Pharmacy and costs

If prescribed, medication is processed by a pharmacy. Coverage, prior authorization, formulary rules, supply, cost, and delivery may affect access. These are not guaranteed. Let us know your pharmacy preference; insurer or distribution restrictions may limit options.

Membership is $39 charged every month, $99 charged every three months, or $180 charged every six months. The initial clinical assessment is included after membership enrollment and payment. An optional video visit is $200 per visit; a clinically required video visit is $75 per visit. Medication, pharmacy, laboratory, imaging, and external-care charges are separate. Applicable charges and renewal terms are disclosed before payment.

Your health coverage may affect eligibility for the direct-pay membership. Review the insurance and enrollment requirements before paying; using prescription benefits at a pharmacy does not override those requirements. Review insurance and enrollment eligibility

This consent does not authorize recurring charges or accept a refund policy. Those terms are presented separately. See the Membership, Cancellation and Refund Policy for the approved financial terms, including what happens if you decline a required service or cannot be treated remotely.

11 Privacy and records

Your assessment, relevant messages, clinician decisions, prescriptions, and consent are documented in your record. The Notice of Privacy Practices explains applicable uses and disclosures of health information and your rights. The Privacy Policy addresses website and platform information practices. This consent is not a blanket authorization to disclose records for unrelated purposes.

Use a private location, protect your account, avoid shared access links, and tell us if someone else can hear or see your visit. Information visible in ordinary notifications may be seen by others with access to your device. Use the secure clinical channel for medical information rather than general support email.

You may request records and corrections through the process in the Notice of Privacy Practices. Withdrawing telehealth consent does not delete information we are required or permitted to retain.

12 Other participants accommodations and recording

Tell the clinician if another person is with you. We will identify others participating from our side and seek your permission for nonessential observers. You may ask questions privately or object to a nonessential observer. A support person helping with technology does not automatically have authority to consent for you or access your account.

Contact contact@teleheadache.com for communication assistance or an accessible consent format. We will discuss appropriate accommodations, including language assistance where required. A clinical question should be addressed by an appropriate member of the care team before you decide.

TeleHeadache does not record visits under its launch policy. A future proposal to record would require separate disclosure and any required express consent. Do not record a visit without first discussing it and obtaining required permission. This telehealth consent does not authorize an audio recording, transcription service, or AI recording assistant.

13 Technology assisted clinical work

Approved software may organize your answers, identify missing information, flag possible concerns, or help prepare information for clinician review. It may produce incomplete or incorrect results. A licensed clinician remains responsible for clinical decisions. An automated summary, score, or recommendation is not your final diagnosis or prescription.

This consent does not authorize use of identifiable health information for unrelated advertising, public AI training, or research requiring separate permission.

14 Declining or withdrawing consent

You may decline telehealth or withdraw consent for future telehealth services by notifying your clinician through the portal or contacting admin@teleheadache.com. Ask for confirmation that the request was received. In a live visit, tell the clinician directly. Withdrawal applies prospectively and does not undo services already provided or lawful record retention.

Because TeleHeadache provides care remotely, withdrawal may prevent further clinical services through this program. We will explain appropriate next steps for continuity and records. Do not stop prescribed treatment abruptly without appropriate medical advice. If withdrawal means we can no longer provide membership care, we stop future renewal and apply the unused-period, refund, and transition rules in the Membership, Cancellation and Refund Policy. We will confirm the resulting membership and billing status. Withdrawing electronic-delivery consent is a separate choice, addressed in the electronic-record disclosure. No additional telehealth clinical service is permitted merely because membership remains active.

15 Florida addendum

Florida law recognizes synchronous and asynchronous telehealth. Providers must act within their authorized scope and meet the applicable professional standard of care. Telehealth services must be documented to the same standard as in-person services. A remote evaluation must be sufficient for the care provided; another examination or service may still be necessary.

TeleHeadache obtains written telehealth consent as its service standard. This does not replace other informed-consent requirements or your right to receive information about proposed treatment, alternatives, and significant risks. The treating professional must hold the required Florida authorization. When an out-of-state telehealth registrant provides care, the applicable Florida Department of Health registration information will be linked in the clinician's disclosures.

Nothing in this consent waives a legal right, excuses negligent care, or reduces a clinician's professional responsibilities.

16 Your consent decision

Before agreeing, confirm that you understand the remote-care process, the limitations described here, the alternatives available to you, and how to seek urgent or emergency care. You must be an adult consenting for yourself or have legally verified authority to act for the patient. You may ask questions and decline without being pressured.

Consent statement: “I have reviewed this Telehealth Informed Consent, had an opportunity to ask questions and receive answers, and voluntarily consent to the telehealth services described. I understand that additional information, video, or in-person care may be needed and that treatment and prescriptions are not guaranteed.”

Electronic signing occurs in the secure portal after the separate electronic-record disclosure. You may request a paper copy or ask about another supported consent method. The electronic-record disclosure explains access requirements, how to update contact information, and how to withdraw electronic-delivery consent. That withdrawal is separate from declining telehealth itself.

For consent questions, contact admin@teleheadache.com. Online access is available 24/7. Nonurgent clinical messages are generally answered within one business day, Eastern Time; send them through the patient portal. For an emergency, call 911.